There is a known association between need for transfusion and short-term outcomes in patients undergoing cardiac surgery. However, long-term data are lacking in the contemporary literature.
All patients who underwent open cardiac surgery from 2010 to 2018 were included, with the exception of transplant, ventricular assist device and patients requiring circulatory arrest. Primary outcome included short and long-term mortality. Secondary outcomes included postoperative complications and hospital readmissions.
The total patient population included 14,281 patients with a median follow-up of 4.03 (2.25 – 6.1) years. Outcomes were stratified into patients with (n=6239) or without (n=8042) packed red blood cell (PRBC) use. Patients with PRBC transfusions had significantly (p<0.001) worse postoperative outcomes compared to those without PRBC use including higher operative mortality (6.89% vs 0.98%), return to OR (17.8% vs 1.61%), pneumonia (7.84% vs 0.98%), stroke (3.22% vs 1.51%), sepsis (2.66% vs 0.20%), renal failure (8.42% vs 1.12%), and dialysis (5.74% vs 0.42%). On multivariate analysis, PRBC transfusion was an independent predictor of mortality [HR 2.39 (2.08, 2.64); p<0.001)] and hospital readmission [HR 1.15 (1.09, 1.21); p<0.001]. Total units of PRBCs was directly associated with mortality [HR 1.09 (1.08, 1.09); p<0.001] and hospital readmissions [HR 1.02 (1.01, 1.03); p<0.005].
Patients with perioperative PRBC transfusions have increased operative and long-term mortality and hospital readmissions. Total units of PRBC transfused was directly associated with mortality and readmissions.
Copyright © 2020. Published by Elsevier Inc.