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Volume 32, Nº 6, November and December 2019

   

DOI: http://www.dx.doi.org/10.5935/2359-4802.20190040

ORIGINAL ARTICLE

Adverse Events and Risk Factors of Blood Transfusion in Cardiovascular Surgery: A Prospective Cohort Study

Ana Paula Tagliari

Lucas Molinari Veloso da Silveira

Adriano Nunes Kochi

Anderson Castro de Souza

Marcelo Curcio Gib

Tanara Martins de Freitas

Cristiano Blaya Martins

Leandro Totti Cavazzola

Orlando Carlos Belmonte Wender





Abstract

Background: Hemodilution, transoperative bleeding and cardiopulmonary bypass (CPB) are some of the factors associated with high transfusion rates in cardiac surgery.

Objective: To analyze the incidence of blood transfusion and early postoperative outcomes in cardiac surgery patients.

Methods: Cohort study of patients undergoing cardiac surgery in a university hospital, consecutively enrolled from May 2015 to February 2017. Data were prospectively collected and comparisons were made between two patients’ groups: transfused and not transfused. Student's t-test, chi-square test, and logistic regression were used, and a p-value < 0.05 was considered significant.

Results: Among the 271 patients evaluated, 100 (37%) required transfusion in the transoperative (32.1%) and/or postoperative periods (19.5%). The following predictors of transfusion were identified by multivariate analysis: EuroScore II (OR 1.2); chronic kidney disease (CKD) (OR 3.2); transoperative bleeding ≥ 500 mL (OR 6.7); baseline hemoglobin (Hb) ≤ 10 g/dL (OR 11.5); activated partial thromboplastin time (aPTT) (OR 1.1) and CPB duration (OR 1.03). Transfusion was associated with prolonged mechanical ventilation (≥ 24h) (2.4% vs. 23%), delirium (5.9% vs. 18%), bronchopneumonia (1.2% vs. 16%), acute renal failure (3.5% vs. 25%), acute on CKD (0.6% vs. 8%), stroke or transient ischemic attack (1.8% vs. 8%), intensive care unit stay ≥ 72 h (36% vs. 57%), longer hospital stay (8 ± 4 days vs. 16 ± 15 days), as well as increased early mortality (1.75% vs. 15%).

Conclusion: EuroScore II, CKD, major transoperative bleeding, preoperative Hb and aPTT values and CPB time were independent predictors of transfusion, which was associated with a higher rate of adverse outcomes, including early mortality. (Int J Cardiovasc Sci. 2019;32(6):565-572)

Keywords: Cardiac Surgical Procedures/mortality; Blood Transfusion; Intraoperative Care/adverse effects; Postoperative Complications/prevention and control; Risk assessment.