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Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients

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Abstract

Objective

To evaluate postoperative red blood cell (RBC) transfusion and its association with postoperative cardiac events and multiorgan morbidity in uncomplicated cardiac surgery patients.

Methods

A cohort of 945 patients from the 5,436 coronary artery bypass grafting patients enrolled in the international Multicenter Study of Perioperative Ischemia (McSPI) Epidemiology II (EPI II) study was investigated. Inclusion criteria were low to moderate risk profile, postoperative hemoglobin level ≥10 g/dl, minimal postoperative blood loss, and no evidence of any morbid event on the day of surgery. RBC transfusion was assessed during the first 24 postoperative hours and cardiac as well as multiorgan outcomes from postoperative day 2 to hospital discharge. Multivariate analysis was applied to assess the effect of RBC transfusion on multiorgan outcomes. A secondary propensity score analysis was performed in 4,465 patients without early postoperative morbid outcomes.

Results

Transfused patients (193/945, 20.4%) were more likely to suffer cardiac events (P = 0.03), harvest-site infection (P = 0.002), and composite morbidity outcome (P = 0.04). RBC transfusion was associated with cardiac events on multivariate as well as on propensity score analysis (adjusted odds ratio, 1.39; 95% confidence interval, 1.01–1.92; P = 0.04), and with harvest-site infection on multivariate analysis. Additionally, propensity score analysis suggested possible associations of RBC transfusion with increased risks for composite morbidity outcome and in-hospital mortality, renal morbidity, pneumonia, and mediastinitis.

Conclusions

The data suggest a potential association between postoperative RBC transfusion and increased morbidity for cardiac surgery patients with low to moderate mortality risk profiles, adequate hemoglobin levels, and low bleeding rates.

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Acknowledgments

Supported by a grant from the Ischemia Research and Education Foundation, San Bruno, CA, USA. IREF, an independent and nonprofit foundation, supported data collection, including site grants, central analysis and data disposition, manuscript grants, and publication of the findings. Stephanie Snyder-Ramos was supported by a grant (SN 18/1-1) from the Deutsche Forschungsgemeinschaft, Bonn, Germany. We are indebted to Yi-Shin Weng, Sc.D. and to Shirley Wang, Sc.D., for their valuable assistance in the initial statistical analysis. Our sincere appreciation to Brenda Xavier, Business Manager for the MCSPI Research Group; Diane Beatty, administrative assistant at IREF; and Cynthia Dietzel, MD, Director, Scientific Projects, IREF, for their work in bringing the manuscript through the various editorial stages.

Conflict of interest

No authors reported financial conflict of interest relevant to this article.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Ludwig-Maximilians-Universität München, Marchinoninistr. 15, 81377, München, Germany

    Patrick Möhnle

  2. Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany

    Stephanie A. Snyder-Ramos

  3. Ischemia Research and Education Foundation, San Bruno, CA, USA

    Yinghui Miao

  4. Department of Anesthesiology and Intensive Care Medicine, University of Graz, Graz, Austria

    Alexander Kulier

  5. Department of Anesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Cologne, Germany

    Bernd W. Böttiger

  6. Department of Laboratory Medicine, University of California School of Medicine, San Francisco, CA, USA

    Jack Levin

  7. Ischemia Research and Education Foundation, San Bruno, CA, USA

    Dennis T. Mangano

  8. Multicenter Study of Perioperative Ischemia (McSPI) Research Group, San Bruno, CA, USA

    Patrick Möhnle, Stephanie A. Snyder-Ramos, Alexander Kulier, Bernd W. Böttiger & Jack Levin

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  1. Patrick Möhnle
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  2. Stephanie A. Snyder-Ramos
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  3. Yinghui Miao
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  4. Alexander Kulier
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  5. Bernd W. Böttiger
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  6. Jack Levin
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  7. Dennis T. Mangano
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Corresponding author

Correspondence to Patrick Möhnle.

Additional information

P. Möhnle and S. A. Snyder-Ramos contributed equally to the manuscript and share first authorship.

For the Multicenter Study of Perioperative Ischemia (McSPI) Research Group. See Appendix for a complete list of the investigators and centers.

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Appendix

Appendix

The Ischemia Research and Education Foundation (IREF) is an independent nonprofit foundation, formed in 1987, which develops clinical investigators via observational studies and clinical trials addressing ischemic injury of the heart, brain, kidney, and gastrointestinal tract. IREF provided all funding for execution of the study, collection of the data, and analysis and publication of the findings. The Multicenter Study of Perioperative Ischemia (McSPI) Research Group, formed in 1988, is an association of 160 international medical centers located in 23 countries, organized through and supported by grants from IREF.

The following institutions and persons coordinated the McSPI EPI-II study. Study Chairman—D. Mangano; Senior Editor—J. Levin, L. Saidman; Study Design and Analysis Center: Ischemia Research and Education Foundation—P. Barash, A. Herskowitz, C. Dietzel, Y. Miao, I.C. Tudor. Editorial/Administrative Group—D. Beatty, I. Lei, B. Xavier.

The following institutions and persons participated in the McSPI EPI-II Study. Centers and investigators: USA—University of Chicago, Weiss Memorial Hospital—S. Aronson; Beth Israel Hospital—M. Comunale; Massachusetts General—M. D’Ambra; University of Rochester—M. Eaton; Baystate Medical Center—R. Engelman; Baylor College of Medicine—J. Fitch; Duke Medical Center—K. Grichnik; UTHSCSA-Audie Murphy VA, UTHSCSA-University Hospital—C.B. Hantler; St. Luke’s Roosevelt Hospital—Z. Hillel; New York University Medical Center—M. Kanchuger, J. Ostrowski; Stanford University Medical Center—C.M. Mangano; Yale University School of Medicine—J. Mathew, M. Fontes, P. Barash; University of Wisconsin—M. McSweeney, R. Wolman; University of Arkansas for Medical Sciences—C.A. Napolitano; Discovery Alliance, Inc.—L.A. Nesbitt; VA Medical Center, Milwaukee—N. Nijhawan; Texas Heart Institute, Mercy Medical Center—N. Nussmeier; University of Texas Medical School, Houston—E.G. Pivalizza; University of Arizona—S. Polson; Emory University Hospital—J. Ramsay; Kaiser Foundation Hospital—G. Roach; Thomas Jefferson University Hospital, MCP Hahnemann University Hospital—N. Schwann; VAMC Houston—S. Shenaq; Maimonides Medical Center—K. Shevde; Mt. Sinai Medical Center—L. Shore-Lesserson, D. Bronheim; University of Michigan—J. Wahr; University of Washington—B. Spiess; VA Medical Center, S.F.—A. Wallace; Austria—University of Graz—H. Metzler; Canada—University of British Columbia—D. Ansley, J.P. O’Connor; The Toronto Hospital—D. Cheng; Laval Hospital, Quebec—D. Côte; Health Sciences Centre-University of Manitoba—P. Duke; University of Ottawa Heart Institute—J.Y. Dupuis, M. Hynes; University of Alberta Hospital—B. Finegan; Montreal Heart Institute—R. Martineau, P. Couture; St. Michael’s Hospital, University of Toronto—D. Mazer; Colombia—Fundacion Clinico Shaio—J.C. Villalba, M.E. Colmenares; France—CHRU Le Bocage—C. Girard; Hospital Pasteur—C. Isetta; Germany—Universität Wϋrzburg—C. A. Greim, N. Roewer; Universität Bonn—A. Hoeft; University of Halle—R. Loeb, J. Radke; Westfalische Wilhelms-Universität Munster—T. Mollhoff; Universität Heidelberg—J. Motsch, E. Martin; Universität Krankenhaus Eppendorf—J. Scholz, P. Tonner; Georg-August Universität Göttingen—H. Sonntag; Ludwig-Maximilians Universität München—E. Ott; Ludwig-Maximilians Universität München (Department of Cardiac Surgery)—P. Überfuhr; Hungary—Orszagos Kardiologiai Intezet—A. Szekely; India—Escorts Heart Institute—R. Juneja; Apollo Hospital—G. Mani; Israel—Hadassah University Hospital—B. Drenger, Y. Gozal, E. Elami; Italy—San Raffaele Hospital, Universita de Milano—C. Tommasino; Mexico—Instituto Nacional de Cardiologia—P. Luna;. The Netherlands—University Hospital Maastricht—P. Roekaerts, S. DeLange; Poland—Institute of Cardiology—R. Pfitzner; Romania—Institute of Cardiology—D. Filipescu; Thailand—Siriraj Hospital—U. Prakanrattana; UK—Glenfield Hospital—D.J.R. Duthie; St. Thomas’ Hospital—R.O. Feneck; The Cardiothoracic Centre, Liverpool—M.A. Fox; South Cleveland Hospital—J.D. Park; Southampton General Hospital—D. Smith; Manchester Royal Infirmary—A. Vohra; Papworth Hospital— A. Vuylsteke, R.D. Latimer.

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Möhnle, P., Snyder-Ramos, S.A., Miao, Y. et al. Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients. Intensive Care Med 37, 97–109 (2011). https://doi.org/10.1007/s00134-010-2017-z

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