Eeva-Maija Kinnunen1, Marco Zanobini2, Francesco Onorati3, Debora Brascia4, Giovanni Mariscalco5, Ilaria Franzese3, Vito G Ruggieri6, Karl Bounader6, Andrea Perrotti7, Francesco Musumeci8, Giuseppe Santarpino9, Daniele Maselli10, Saverio Nardella10, Helmut Gulbins11, Riccardo Gherli8, Antonino S Rubino12, Carmelo Mignosa12, Marisa De Feo13, Giuseppe Gatti14, Francesco Santini15, Antonio Salsano15, Magnus Dalén16, Matteo Saccocci2, Daniel Reichart11, Giuseppe Faggian3, Tiziano Gherli17, Francesco Nicolini17, Fausto Biancari4. 1. Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: eevamaija.kinnunen@gmail.com. 2. Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Milan, Italy. 3. Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy. 4. Department of Surgery, Oulu University Hospital, Oulu, Finland. 5. Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK. 6. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 7. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 8. Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy. 9. Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany. 10. Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy. 11. Hamburg University Heart Center, Hamburg, Germany. 12. Centro Cuore Morgagni, Pedara, Italy. 13. Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy. 14. Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. 15. Division of Cardiac Surgery, University of Genoa, Genoa, Italy. 16. Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 17. Division of Cardiac Surgery, University of Parma, Parma, Italy.
Abstract
PURPOSE: To investigate the impact of minor perioperative bleeding requiring transfusion of 1-2 red blood cell (RBC) units on the outcome after coronary artery bypass grafting (CABG). METHODS: Sixteen cardiac surgical centers contributed to the prospective European CABG registry (E-CABG). 1014 patients receiving 1-2 RBC units during or after isolated CABG were compared to 2264 patients not receiving RBCs. RESULTS: In 827 propensity score matched pairs, transfusion of 1-2 RBC units did not affect the risk of in-hospital/30-day death (p=0.523) or stroke (p=0.804). However, RBC transfusion was associated with an increased risk of acute kidney injury (p=0.008), sternal wound infection (p=0.001), postoperative use of antibiotics (p=0.001), prolonged use of inotropes (p<0.0001), use of intra-aortic balloon pump (p=0.012), length of intensive care unit stay (p<0.0001) and length of in-hospital stay (p<0.0001). Matched paired analysis excluding pre- and postoperative critical hemodynamic conditions showed that RBC transfusion was associated with an increased risk of major complications except in-hospital/30-day death. CONCLUSION: Minor perioperative bleeding and subsequent transfusion of 1-2 RBC units did not affect the risk of early death, but increased the risk of other major adverse events. Minimizing perioperative bleeding and prevention of even low-volume RBC transfusion may improve the outcome after CABG.
PURPOSE: To investigate the impact of minor perioperative bleeding requiring transfusion of 1-2 red blood cell (RBC) units on the outcome after coronary artery bypass grafting (CABG). METHODS: Sixteen cardiac surgical centers contributed to the prospective European CABG registry (E-CABG). 1014 patients receiving 1-2 RBC units during or after isolated CABG were compared to 2264 patients not receiving RBCs. RESULTS: In 827 propensity score matched pairs, transfusion of 1-2 RBC units did not affect the risk of in-hospital/30-day death (p=0.523) or stroke (p=0.804). However, RBC transfusion was associated with an increased risk of acute kidney injury (p=0.008), sternal wound infection (p=0.001), postoperative use of antibiotics (p=0.001), prolonged use of inotropes (p<0.0001), use of intra-aortic balloon pump (p=0.012), length of intensive care unit stay (p<0.0001) and length of in-hospital stay (p<0.0001). Matched paired analysis excluding pre- and postoperative critical hemodynamic conditions showed that RBC transfusion was associated with an increased risk of major complications except in-hospital/30-day death. CONCLUSION: Minor perioperative bleeding and subsequent transfusion of 1-2 RBC units did not affect the risk of early death, but increased the risk of other major adverse events. Minimizing perioperative bleeding and prevention of even low-volume RBC transfusion may improve the outcome after CABG.