Journal article
Predictors of Cardiac Surgery Patients Who Tolerate Blood Conservation in Cardiac Surgery
The Annals of thoracic surgery, Vol.107(6), pp.1737-1746
06/2019
DOI: 10.1016/j.athoracsur.2018.11.070
PMID: 30639361
Abstract
Whether there is a cardiac surgical patient population that does not incur harm from blood conservation is unknown. This study aimed to identify patient characteristics associated with patients who safely tolerate blood conservation.
We conducted a retrospective review of consecutive patients undergoing isolated coronary artery bypass graft surgery or isolated aortic valve replacement, or concomitant coronary artery bypass graft surgery and aortic valve replacement between 2011 and 2016, during which blood conservation intervention took place. Logistic regression derived from the preintervention cohort was applied to the postintervention cohort to identify patient characteristics associated with those predicted to be transfused in the preintervention era but were not in the postintervention era.
In this series of 2,701 adult patients undergoing cardiac operations, blood conservation intervention in 2014 led to a 52% reduction in red blood cell transfusion. Between preintervention and postintervention cohorts, there was no significant difference in the measured outcomes. A regression model derived from the preintervention cohort was applied to the postintervention cohort to identify predictors of cohort that do not derive benefit from liberal transfusion. This model demonstrated such patient characteristics to be age more than 75 years (odds ratio [OR] 1.71, 95% confidence interval [CI]: 1.09 to 2.68, p = 0.033), body mass index less than 30 kg/m
(OR 1.5, 95% CI: 1.02 to 2.20, p = 0.044), lowest intraoperative hematocrit between 22 and 25 (OR 1.77, 95% CI: 1.16 to 2.68, p < 0.001), and cardiopulmonary bypass use (OR 4.50, 95% CI: 2.25 to 9.01, p < 0.001).
Blood conservation can successfully yield reduction in perioperative blood product use, with associated decrease in the risk of postoperative renal failure. A select patient population who may tolerate blood conservation safely was identified, and that may guide a targeted blood conservation effort.
Details
- Title: Subtitle
- Predictors of Cardiac Surgery Patients Who Tolerate Blood Conservation in Cardiac Surgery
- Creators
- Makoto Mori - Yale UniversityHaoran Zhuo - Yale UniversityFangfang Liu - Yale UniversityMichael LaLonde - Yale UniversityKeith J Pelletier - Yale UniversityRitu Agarwal - Yale New Haven HospitalArnar Geirsson - Yale UniversityMohsen Karimi - Yale UniversityAla Haddadin - Yale UniversityPramod Bonde - Yale UniversityYawei Zhang - Yale UniversityAbeel A Mangi - Yale University
- Resource Type
- Journal article
- Publication Details
- The Annals of thoracic surgery, Vol.107(6), pp.1737-1746
- DOI
- 10.1016/j.athoracsur.2018.11.070
- PMID
- 30639361
- ISSN
- 0003-4975
- eISSN
- 1552-6259
- Grant note
- UL1 TR001863 / NCATS NIH HHS
- Language
- English
- Date published
- 06/2019
- Academic Unit
- Cardiothoracic Surgery
- Record Identifier
- 9984557948702771
Metrics
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