Increased mortality, morbidity, and cost associated with red blood cell transfusion after cardiac surgery
- 1 November 2008
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Cardiology
- Vol. 23 (6), 607-612
- https://doi.org/10.1097/hco.0b013e328310fc95
Abstract
Literature since 2006 was reviewed to identify the harms and costs of red blood cell (RBC) transfusion. Several studies, in people having various cardiac surgery operations, found strong associations of RBC transfusion with mortality and postoperative morbidity. The effect on mortality was strongest close to the time of operation but extended to 5 years. Morbidity outcomes included serious wound and systemic infections, renal failure, prolonged ventilation, low cardiac index, myocardial infarction, and stroke. RBC transfusion was also strongly associated with increased cardiac intensive care unit and ward postoperative stay, and hence, increased cost of admission; available studies did not consider all resources used and the associated costs. The harms of RBC transfusion have potentially serious and long-term consequences for patients and are costly for health services. This evidence should shift clinicians' equipoise towards more restrictive transfusion practice. The immediate aim should be to avoid transfusing a small number of RBC units for general malaise attributed to anaemia, a practice that appears to occur in about 50% of transfused patients. Randomized trials comparing restrictive and liberal transfusion triggers are urgently needed to directly compare the benefits and harms from RBC transfusion.Keywords
This publication has 23 references indexed in Scilit:
- Risk Associated With Preoperative Anemia in Cardiac SurgeryCirculation, 2008
- Transfusion Strategies for Patients in Pediatric Intensive Care UnitsNew England Journal of Medicine, 2007
- Indications for Blood Transfusion in Cardiac SurgeryThe Annals of Thoracic Surgery, 2006
- Interval estimation by simulation as an alternative to and extension of confidence intervalsInternational Journal of Epidemiology, 2004
- Evaluating non-randomised intervention studiesHealth Technology Assessment, 2003
- Where does blood go? Prospective observational study of red cell transfusion in north EnglandBMJ, 2002
- Recent developments: Blood transfusion medicineBMJ, 2002
- A survey of blood transfusion practice in UK cardiac surgery unitsCritical Care, 2001
- A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical CareNew England Journal of Medicine, 1999
- Variability in Transfusion Practice for Coronary Artery Bypass Surgery Persists Despite National Consensus Guidelines Anesthesiology, 1998