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Lee E, Hart D, Ruggiero A, Dowling O, Ausubel G, Preminger J, Vitiello C, Shore-Lesserson L. The Relationship Between Transfusion in Cardiac Surgery Patients and Adverse Outcomes. J Cardiothorac Vasc Anesth 2024; 38:1492-1498. [PMID: 38580475 DOI: 10.1053/j.jvca.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES To understand if red blood cell (RBC) transfusions are independently associated with a risk of mortality, prolonged intubation, or infectious, cardiac, or renal morbid outcomes. DESIGN A retrospective review. SETTING A single-institution university hospital. PARTICIPANTS A total of 2,458 patients undergoing coronary bypass artery graft and/or valvular surgery from July 2014 through January 2018. INTERVENTIONS No interventions were done. MEASUREMENTS AND MAIN RESULTS The primary outcome was the occurrence of an adverse event or prolonged intubation. Infectious, cardiac, and renal composite outcomes were also defined. These composites, along with mortality, were analyzed individually and then combined to form the "any adverse events" composite. Preoperative demographic and intraoperative parameters were analyzed as univariate risk factors for adverse outcomes. Logistic regression was used to screen variables, with a p value criterion of p < 0.05 for entry into the model selection procedure. A backward selection algorithm was used with variable entry and retention criteria of p < 0.05 to select the final multivariate model. Multivariate logistic regression models were used to determine whether there was an association between the volume of RBC transfusion and the defined adverse event after adjusting for covariates. A p value < 0.01 was considered statistically significant in the final model of each aim to adjust for multiple comparisons. The final logistic models for each of the following outcomes indicate an increased risk of that outcome per each additional unit of RBC transfused. For prolonged intubation, the odds ratio (OR) was 1.493 (p < 0.0001), OR = 1.358 (p < 0.0001) for infectious composite outcomes, OR = 1.247 (p < 0.0001) for adverse renal outcomes, and OR = 1.467 (p < 0.0001) for any adverse event. CONCLUSIONS The authors demonstrated a strong independent association between RBC transfusion volume and adverse outcomes after cardiac surgery. Efforts should be undertaken, such as preoperative anemia management and control of coagulopathy, in order to minimize the need for RBC transfusion.
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Affiliation(s)
- Eric Lee
- Department of Anesthesiology, Northwell Health, New Hyde Park, NY
| | - Daniel Hart
- Department of Anesthesiology, Northwell Health, New Hyde Park, NY
| | - Andrea Ruggiero
- Department of Anesthesiology, Northwell Health, New Hyde Park, NY
| | - Oonagh Dowling
- Department of Anesthesiology, Northwell Health, New Hyde Park, NY
| | - Gavriel Ausubel
- Department of Anesthesiology, Northwell Health, New Hyde Park, NY
| | | | - Chad Vitiello
- Department of Anesthesiology, Northwell Health, New Hyde Park, NY
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Abukhodair A, Alqarni MS, Alzahrani A, Bukhari ZM, Kadi A, Baabbad FM, Algarni A, Jamalallail S, Almohammadi M, Bennett SR. Risk Factors for Postoperative Infections in Cardiac Surgery Patients: A Retrospective Study. Cureus 2023; 15:e43614. [PMID: 37719533 PMCID: PMC10504570 DOI: 10.7759/cureus.43614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Background and objective Cardiac surgery is one of the most common surgical procedures globally; its incidence has been on the rise due to the faster pace of population aging thanks to technological and epidemiological advances. Patients who undergo cardiac surgeries may face various postoperative complications that might affect their survival, and one of these major complications is infection. Nosocomial pneumonia, surgical site infection (SSI), mediastinitis, bacteremia, and sepsis are common infections encountered after surgeries. In this study, we aimed to determine the common risk factors related to postoperative infections at the King Faisal Cardiac Center from January 2014 to September 2020. Materials and methods Records from 364 patients who underwent cardiac surgery and were aged above 18 years were assessed for postoperative infections in this retrospective cohort study. Patients who were immunosuppressed or had active systemic infections were excluded. Consent was waived by the Institutional Review Board. All procedures were performed at the King Faisal Cardiac Center, National Guard Hospital, Jeddah. Results Of the total 364 patients, 105 were women and 259 were men. The mean age of the cohort was 59 years (SD = 13) and the mean BMI was 29.1 kg/m2 (SD = 5.3). The study population showed a high prevalence of cardiac risk factors and diseases: diabetes (n = 244, 67%), hypertension (n = 230, 63%), dyslipidemia (n = 144, 40%), smoking (n = 80, 22%), heart failure (n = 41, 11%), and chronic obstructive pulmonary disease (n = 6, 1.6%). The overall rate of postoperative infection was 32.7% (n = 120), and 17 (14%) of these infected patients underwent reoperations for infection. Conclusion Based on a thorough analysis of 364 patients undergoing various cardiac surgical procedures, including a multivariate analysis accounting for preoperative factors, there was a significant association between postoperative infections and hypertension, diabetes, increased preoperative activated partial thromboplastin time, and elevated HbA1c.
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Affiliation(s)
| | - Mohammed S Alqarni
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
- Internal Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
| | | | - Ziad M Bukhari
- Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Ammar Kadi
- Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
- Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Faisal M Baabbad
- Emergency Medicine, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Abdullah Algarni
- Pathology and Laboratory Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
- Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Sahal Jamalallail
- Pathology and Laboratory Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
- Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed Almohammadi
- Hematopathology and Transfusion Medicine, National Guard Hospital, King Abdulaziz Medical City, Jeddah, SAU
- Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Sean R Bennett
- Anesthesiology/Cardiac and Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
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The association between preoperative anemia, blood transfusion need, and postoperative complications in adult cardiac surgery, a single center contemporary experience. J Cardiothorac Surg 2023; 18:10. [PMID: 36611177 PMCID: PMC9824911 DOI: 10.1186/s13019-023-02132-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/02/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The impact of preoperative anemia on postcardiac surgery outcomes is an area of great debate. Although several large-scale studies have been conducted, they have demonstrated conflicting results. A limited number of studies have been conducted in the Middle East. The primary aim of this study was to investigate the association between preoperative anemia and the need for blood transfusions, as well as major postoperative complications. METHODS Adult patients who underwent cardiac surgery at King Faisal Cardiac Center in Jeddah between June 2016 and January 2020 were included in this retrospective cohort study. The study excluded patients with hereditary preoperative anemia. Among the variables studied were variables related to demographics, comorbidities, laboratory data, operation-related data, in-hospital complications, and mortality. RESULTS The mean preoperative hemoglobin (Hb) level was 13.2 g/dL (SD ± 1.8). The overall mortality rate was 4.6%. A lower preoperative Hb level (p value = 0.016), postoperative day 1 WBC count (p-value = 0.003), and prolonged cross clamp time (p value < 0.001) were significantly associated with mortality. A lower Hb level during the preoperative period or within the first three days of surgery was associated with a higher blood transfusion requirement. However, there was no significant association between blood transfusion and postoperative complications. A multivariate stepwise logistic regression model was developed and several pre and intra operative factors were predictive of the need PRBCs transfusion after cardiac surgery (which included: older age, female gender, lower pre-operative hemoglobin and longer cardio-pulmonary bypass time), with had a predictive accuracy of around ~ 86%. CONCLUSION Based on our single center study, patients with preoperative lower Hb levels are at higher risk of mortality. However, blood transfusion does not seem to increase the risk of postoperative complications. Optimal utilization of blood products is an important quality metric and identification of patients at higher risk of requiring PRBCs transfusion prior to cardiac surgery can help in implementing pre or intra operative strategies to minimize the need for transfusion.
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Beleta MI, Abdallah SR, Hammad YM, Yahia HEM, Ali AAE, Mohamed AA, AbdElhameed BM. Noninvasive continuous hemoglobin monitoring of blood transfusion in obstetric procedures. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2153976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mohamed Ibrahim Beleta
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shady Rady Abdallah
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yehia Mohamed Hammad
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam Eldin Mostafa Yahia
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ashraf Abd ElMawgood Ali
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abdallah Mohamed
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Bassant Mohamed AbdElhameed
- Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Gutsche JT, Grant MC, Kiefer JJ, Ghadimi K, Lane-Fall MB, Mazzeffi MA. The Year in Cardiothoracic Critical Care: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2020; 36:45-57. [PMID: 33051148 DOI: 10.1053/j.jvca.2020.09.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/11/2022]
Abstract
In 2019, cardiothoracic and vascular critical care remained an important focus and subspecialty. This article continues the annual series to review relevant contributions in postoperative critical care that may affect the cardiac anesthesiologist. Herein, the pertinent literature published in 2019 is explored and organized by organ system.
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Affiliation(s)
- J T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - M C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J J Kiefer
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - K Ghadimi
- Department of Anesthesiology and Critical Care, Duke University, Durham, NC
| | - M B Lane-Fall
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M A Mazzeffi
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
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