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Fields N, Ather A, Davenport D, Ahmed S, Sekela M. Outcomes associated with absent blood product utilization in Jehovah's witness patients compared to the standard of care in cardiac surgery: A ten-year experience. Perfusion 2024:2676591241258072. [PMID: 38864565 DOI: 10.1177/02676591241258072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
INTRODUCTION For Jehovah's Witness (JW) patients requiring cardiac surgery, various strategies such as preoperative use of erythropoietin stimulating agents (ESAs), intravenous iron (IVI), and non-pharmacologic interventions have emerged to prevent complications from blood loss given transfusion is not acceptable in this population. METHODS Retrospective case-control of cardiac surgeries performed by the same surgeon between 1/1/2011 and 8/30/2021. JW patients were matched to non-JW who received blood products and non-JW who did not receive blood products on a 1:2:2 basis. Patients were matched on procedure, age, gender, and Society of Thoracic Surgeons morbidity score. Eligible patients were aged >18 years and had a sternotomy procedure. The primary efficacy and safety outcomes included mean hematocrit values perioperatively and thrombotic events. RESULTS A total of 27 JW, 52 non-JW transfused, and 53 non-JW not transfused patients were included in the analysis. JW patients had significantly higher mean hematocrits at every time point when compared to non-JW transfused patients and at all time points except clinic and the last recorded operating room value when compared to non-JW not transfused patients. No significant differences in thrombotic rates were found between groups, however there was a numerically higher incidence in the JW population (JW: 7.4%; non-JW transfused: 0%; non-JW not transfused: 1.9%; p = .106). CONCLUSION A blood conservation protocol in a JW population was associated with higher perioperative hematocrit values when compared to matched controls. Further prospective study is warranted before applying similar protocols to other populations given the possibility for an increased rate of venous thromboembolism.
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Affiliation(s)
- Nathan Fields
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ayesha Ather
- Department of Pharmacy Services, University of Kentucky HealthCare, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Dan Davenport
- Division of Healthcare Outcomes and Optimal Patient Services, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Sadiq Ahmed
- Division of Nephrology Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, USA
| | - Michael Sekela
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, KY, USA
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Mavioglu L, Karahan M, Unal EU, Celikten AE, Demir A, Iscan HZ, Ozatik MA. Low-Dose Heparin Protocol in Type A Aortic Dissection Surgeries. Thorac Cardiovasc Surg 2022; 70:616-622. [PMID: 35973776 DOI: 10.1055/s-0042-1755469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We aim to compare the heparin dose regimen in terms of bleeding, reoperation rate due to severe bleeding, and the amount of transfusion of the blood products in patients who underwent surgery for type A aortic dissection (TAAD). MATERIALS AND METHODS Between January 2018 and August 2021, 90 adult patients who underwent for TAAD were included. Primary outcome measures were postoperative bleeding amount and blood product transfusion requirements. Two different protocols performed in TAAD surgery in our clinic. In this pre- and postimplementation study, before October 2019, the standard-dose heparin protocol (SH group) was used and after November 2019, the low-dose heparin protocol (LH group) was used and two groups were compared. Mechanical ventilation duration, length of intensive care unit and hospital stay, postoperative drainage volumes, blood product transfusions, reoperations due to bleeding, and in-hospital mortality rates were recorded. RESULTS The dosages of heparin and activated clotting time values, as well as the additional heparin requirement, were significantly different between the two groups (p < 0.001). Standard-dose heparinization was needed only in 33.3% of patients in the LH group. In the SH group, postoperative total drainage and red blood cell (RBC) transfusion were significantly higher than the LH group (p = 0.036 and p = 0.046, respectively). CONCLUSION We found that the low-dose heparin regimen resulted in significantly less postoperative total drainage and RBC transfusion requirement in patients who underwent for TAAD.
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Affiliation(s)
- Levent Mavioglu
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, Ankara, Turkey
| | - Mehmet Karahan
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, Ankara, Turkey
| | - Ertekin Utku Unal
- Department of Cardiovascular Surgery, Erol Olcok Research and Training Hospital, Hitit University, Corum, Turkey
| | - Ayla Ece Celikten
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, Ankara, Turkey
| | - Asli Demir
- Department of Anesthesiology, Ankara City Hospital Complex, University of Health Sciences, Ankara, Turkey
| | - Hakki Zafer Iscan
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, Ankara, Turkey
| | - Mehmet Ali Ozatik
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, University of Health Sciences, Ankara, Turkey
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Salenger R, Mazzeffi MA. The 7 Pillars of Blood Conservation in Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:504-509. [PMID: 34821153 DOI: 10.1177/15569845211051683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rawn Salenger
- Division of Cardiac Surgery, 12264University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Saint Joseph Medical Center, Towson, MD, USA.,Departments of Anesthesiology and Critical Care Medicine, 43989George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Michael A Mazzeffi
- Division of Cardiac Surgery, 12264University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Saint Joseph Medical Center, Towson, MD, USA.,Departments of Anesthesiology and Critical Care Medicine, 43989George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Li Y, Cheang I, Zhang Z, Zuo X, Cao Q, Li J. Prognostic Association Between Perioperative Red Blood Cell Transfusion and Postoperative Cardiac Surgery Outcomes. Front Cardiovasc Med 2021; 8:730492. [PMID: 34631829 PMCID: PMC8497961 DOI: 10.3389/fcvm.2021.730492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/24/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: To investigate the correlation between red blood cell transfusion and clinical outcome in patients after cardiac surgery. Methods: Demographic, clinical characteristics, treatment with/without transfusion, and outcomes of patients after cardiac surgery from the Medical Information Mart for Intensive Care—III database were collected. Patients were divided into two groups according to perioperative transfusion. A multivariable logistic regression analysis was utilized to adjust for the effect of red blood cell transfusion on outcomes for baseline and covariates and to determine its association with outcomes. Results: In total, 6,752 patients who underwent cardiac surgery were enrolled for the analysis. Among them, 2,760 (40.9%) patients received a perioperative transfusion. Compared with patients without red blood cell transfusion, transfused patients demonstrated worse outcomes in inhospital mortality, 1-year mortality, and all-cause mortality. Adjusting odds ratios (ORs) for the significant characteristic, patients with perioperative transfusion remained significantly associated with an increased risk of inhospital mortality [OR = 2.8, 95% confidence interval (CI) 1.5–5.1, P = 0.001], 1-year mortality (OR = 2.0, 95% CI 1.4–2.7, P < 0.001), and long-term mortality (OR = 2.2, 95% CI 1.8–2.8, P < 0.001). Conclusion: Perioperative red blood cell transfusion is associated with a worse prognosis of cardiac surgery patients. Optimal perioperative management and restricted transfusion strategy might be considered in selected patients.
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Affiliation(s)
- Yanxiu Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhongwen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangrong Zuo
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Quan Cao
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinghang Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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5
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Paiva PP, Leite FM, Antunes PE, Antunes MJ. Risk-Prediction Model for Transfusion of Erythrocyte Concentrate During Extracorporeal Circulation in Coronary Surgery. Braz J Cardiovasc Surg 2021; 36:323-330. [PMID: 33656832 PMCID: PMC8357385 DOI: 10.21470/1678-9741-2020-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Our objective was to identify preoperative risk factors and to develop and validate a risk-prediction model for the need for blood (erythrocyte concentrate [EC]) transfusion during extracorporeal circulation (ECC) in patients undergoing coronary artery bypass grafting (CABG). METHODS This is a retrospective observational study including 530 consecutive patients who underwent isolated on-pump CABG at our Centre over a full two-year period. The risk model was developed and validated by logistic regression and bootstrap analysis. Discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow (H-L) test, respectively. RESULTS EC transfusion during ECC was required in 91 patients (17.2%). Of these, the majority were transfused with one (54.9%) or two (41.8%) EC units. The final model covariates (reported as odds ratios; 95% confidence interval) were age (1.07; 1.02-1.13), glomerular filtration rate (0.98; 0.96-1.00), body surface area (0.95; 0.92-0.98), peripheral vascular disease (3.03; 1.01-9.05), cerebrovascular disease (4.58; 1.29-16.18), and hematocrit (0.55; 0.48-0.63). The risk model developed has an excellent discriminatory power (AUC: 0,963). The results of the H-L test showed that the model predicts accurately both on average and across the ranges of deciles of risk. CONCLUSIONS A risk-prediction model for EC transfusion during ECC was developed, which performed adequately in terms of discrimination, calibration, and stability over a wide spectrum of risk. It can be used as an instrument to provide accurate information about the need for EC transfusion during ECC, and as a valuable adjunct for local improvement of clinical practice. Key Findings: Risk factors with the greatest prediction for EC transfusion. Take-Home Message: The implementation of this model would be an important step in optimizing and improving the quality of surgery.
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Affiliation(s)
- Patrícia Pinheiro Paiva
- Department of Clinical Pharmacology, Hospital and University Centre of Coimbra, Coimbra, Portugal.,Department of Clinical Pharmacology, University of Coimbra Faculty of Medicine, Coimbra, Portugal
| | - Filipe Miguel Leite
- Department of Cardiothoracic Surgery, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Pedro E Antunes
- Department of Cardiothoracic Surgery, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Manuel J Antunes
- Department of Cardiothoracic Surgery, University of Coimbra Faculty of Medicine, Coimbra, Portugal
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6
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Nguyen Q, Meng E, Berube J, Bergstrom R, Lam W. Preoperative anemia and transfusion in cardiac surgery: a single-centre retrospective study. J Cardiothorac Surg 2021; 16:109. [PMID: 33892775 PMCID: PMC8063400 DOI: 10.1186/s13019-021-01493-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/09/2021] [Indexed: 02/03/2023] Open
Abstract
Background Preoperative anemia and transfusion are associated with worse outcomes. This study aims to identify the prevalence of preoperative anemia, transfusion rates on surgery day, and predictors of transfusion in elective cardiac surgery patients at our centre. We also aim to evaluate our preoperative intervention program, and examine the intervention window for anemia before surgery. Methods This study included 797 adult patients who underwent elective cardiac surgery at a tertiary hospital. Multivariable logistic regression analysis was used to identify predictors of transfusion on surgery day. Results Preoperative anemia was present in 15% of patients. Anemic patients had a significantly higher transfusion rate at 53% compared to 10% in non-anemic patients. Hemoglobin concentration, estimated glomerular filtration rate (eGFR), body surface area (BSA), and total cardiopulmonary bypass time were predictive of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day, however, referral to the blood conservation clinic was only done for 8% of anemic patients and treatment was initiated in 3% of anemic patients. Among the 3 anemic patients who received treatment, 2 did not require blood transfusion on surgery day. Conclusions Preoperative anemia is present in 15% of patients at our centre and these patients have 53% transfusion rates on surgery day. Hemoglobin concentration, eGFR, BSA, and total cardiopulmonary bypass time were predictors of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day. Referral and anemia treatment were infrequently initiated in preoperative anemic patient.
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Affiliation(s)
- Quynh Nguyen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Eric Meng
- Division of Anesthesiology & Pain Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada
| | - Joel Berube
- Division of Anesthesiology & Pain Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada
| | - Richard Bergstrom
- Division of Anesthesiology & Pain Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada
| | - Wing Lam
- Division of Anesthesiology & Pain Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada.
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7
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Evans AS, Weiner M, Jain A, Patel PA, Jayaraman AL, Townsley MM, Shah R, Gutsche JT, Renew JR, Ha B, Martin AK, Linganna R, Leong R, Bhatt HV, Garcia H, Feduska E, Shaefi S, Feinman JW, Eden C, Weiss SJ, Silvay G, Augoustides JG, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2018. J Cardiothorac Vasc Anesth 2018; 33:2-11. [PMID: 30472017 DOI: 10.1053/j.jvca.2018.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Adam S Evans
- Anesthesia Associates of Morristown, Morristown, NJ
| | - Menachem Weiner
- Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Ankit Jain
- Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Prakash A Patel
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Arun L Jayaraman
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Scottsdale, AZ
| | - Mathew M Townsley
- Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama, Birmingham, AL
| | - Ronak Shah
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - J Ross Renew
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Bao Ha
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Archer K Martin
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Regina Linganna
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ron Leong
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Himani V Bhatt
- Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Harry Garcia
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eric Feduska
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shahzad Shaefi
- Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA
| | - Jared W Feinman
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Caroline Eden
- Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Stuart J Weiss
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Silvay
- Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - John G Augoustides
- Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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