| The impact of blood conservation on outcomes in cardiac surgery: is it safe and effective? | |
| | |
MedLine Citation:
|
PMID: 20667328 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Increasing evidence shows that perioperative blood transfusion in cardiac surgery is associated with increased postoperative morbidity and mortality and decreased long-term survival. Tolerance of "permissive anemia" is an important element of perioperative blood conservation strategy. The safety of tolerating perioperative anemia has been a significant deterrent for widespread application of blood conservation. This study examines whether blood conservation is equally safe or superior to the common practice of transfusion in cardiac surgery. METHODS: The total study population consisted of 32,449 patients who underwent isolated coronary artery bypass surgery from June 2000 until December 2004 with complete data from 17 institutions in the State of New Jersey. Englewood Hospital and Medical Center (EH) has a well-established blood conservation program. Five hundred eighty-six EH patients (blood conservation cohort) were compared with a propensity score-matched cohort of 586 patients from the other New Jersey institutions (OH-M) representing the common practice of transfusion. Outcomes were classified as very serious complications, serious complications, or neither (no very serious complication or serious complication). Analysis consisted of McNemar tests and multiple logistic regression. RESULTS: Fewer patients were transfused at EH compared with OH-M (10.6% versus 42.5%; p < 0.0001). Englewood Hospital had 5 (0.8%) deaths versus 15 (2.5%) in the OH-M group (p = 0.02). Of the EH patients, 11.1% experienced a very serious complication or serious complication versus 18.7% in the OH-M cohort (p = 0.0002). Transfusion was associated with an increased risk of an adverse outcome in both cohorts (EH: odds ratio, 7.3; 95% confidence interval, 3.7 to 14.4 versus OH-M: odds ratio, 4.6; 95% confidence interval, 2.8 to 7.7). CONCLUSIONS: Blood conservation is safe and effective in reducing transfusions. Tolerance of perioperative anemia, which is one of the main components of blood conservation, does not increase the risk of complications or death in cardiac surgery. Avoidance of transfusion reduces the risk of complications. This study further solidifies the relationship between transfusion and adverse outcome in cardiac surgery. |
| | |
Authors:
|
David M Moskowitz; Jock N McCullough; Aryeh Shander; James J Klein; Carol A Bodian; Richard S Goldweit; M Arisan Ergin |
Related Documents
:
|
1290778 - Association of coagulation tests with blood use during liver transplantation. 15196318 - Age of blood: does it make a difference? 12448568 - Acute normovolemic haemodilution for management of 4200 ml blood loss during radical pr... 9201158 - Intraoperative autologous transfusion during elective infrarenal aortic reconstruction:... 16051348 - Umbilical cord serum activin a levels are increased in pre-eclampsia with impaired bloo... 11488048 - Diagnostic thermography. |
Publication Detail:
|
Type: Journal Article; Multicenter Study |
Journal Detail:
|
Title: The Annals of thoracic surgery Volume: 90 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2010 Aug |
Date Detail:
|
Created Date: 2010-07-29 Completed Date: 2010-08-24 Revised Date: 2011-12-12 |
Medline Journal Info:
|
Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
|
Languages: eng Pagination: 451-8 Citation Subset: AIM; IM |
Copyright Information:
|
Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
|
Department of Anesthesiology, Critical Care Medicine, Hyperbaric Medicine and Pain Management, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA. david.moskowitz@ehmc.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Anemia / therapy Blood Transfusion / adverse effects* Coronary Artery Bypass* Female Humans Male Postoperative Complications / epidemiology, etiology Treatment Outcome |
| Comments/Corrections | |
Comment In:
|
Ann Thorac Surg. 2011 Nov;92(5):1932; author reply 1932-3
[PMID:
22051303
]
Ann Thorac Surg. 2010 Aug;90(2):458-9 [PMID: 20667329 ] Ann Thorac Surg. 2011 Jun;91(6):2022-3; author reply 2023-4 [PMID: 21620017 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Invited commentary.
Next Document: Invited commentary.