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Perioperative trajectory of haemoglobin, predictors of blood transfusion and tailoring targets for patient blood management interventions: A single-centre, retrospective study of non-emergent cardiac surgery patients Cover

Perioperative trajectory of haemoglobin, predictors of blood transfusion and tailoring targets for patient blood management interventions: A single-centre, retrospective study of non-emergent cardiac surgery patients

Romanian Journal of Anaesthesia and Intensive Care
Volume 28 (2021): Issue 2 (December 2021)
By: ,  ,  ,  ,  ,  ,  ,  ,  ,  ,   and    
Open Access
|Dec 2022
Figures & tables

Figures & Tables

Table 1

Types of surgeries.

Type of surgeryNumber of patients
CABG259 (36.48%)
One valve251 (35.35%)
Two or more valves67 (9.44%)
Valve(s) and CABG60 (8.45%)
Surgery on aorta46 (6.48%)
Other27 (3.8%)

[i] CABG, Coronary artery by-pass grafting.

Figure 1

Study flowchart.

CPB, cardiopulmonary bypass

Table 2

Demographic characteristics and outcomes of the whole cohort, anaemic and non-anaemic patients.

VariablesWhole cohort (n = 710)Hb <13 g/dl (n = 288, 40.5%)Hb ≥13 g/dl (n = 422, 59.4%)P-value
Age64 (58–69)66 (59–71)63 (57–68)<0.001
Male sex, n (%)469 (66%)148 (51.4%)321 (76.0%)<0.001
Chronic kidney disease (eGFR <60 ml/min)58 (8.1%)29 (10%)29 (6.8%)0.058
Hb at hospital admission13.3 (12.3–14.4)12 (11.2–12.6)14.3 (13.5–14.9)<0.001
Hb preoperative13.3 (12.2–14.4)12 (11.2–12.5)14.2 (13.5–14.8)<0.001
Hb postoperative9.9 (8.9–10.8)9.3 (8.5–10.1)10.4 (9.4–11.3)<0.001
Hb at discharge9.7 (9–10.6)9.4 (8.8–10)10.1 (9.2–10.8)<0.001
Duration of surgery (min)270 (220–333)275 (220–347)270 (220–330)0.798
Hospital LOS (days)13 (10–17)14 (10–17)13 (10–16)0.826
ICU LOS (days)2 (2–4)2 (2–4)2 (2–4)0.181
Postoperative bleeding- 24 h (ml)375 (275–550)375 (275–550)375 (275–550)0.325
Surgical re-exploration, n (%)45 (6.3%)23 (8%)22 (5.2%)0.136
Hospital death, n (%)23 (3.2%)13 (4.5%)10 (2.4%)0.113
PRBC transfusion, n (%)369 (52%)206 (71.5%)163 (38.6%)<0.001
Total PRBC transfusion, (n)1 (0–2)2 (0–3)0 (0–1)<0.001
Preoperative PRBC transfusion000
Intraoperative transfusion0 (0–1)1 (0–2)0 (0–1)<0.001
Postoperative transfusion0 (0–1)0 (0–1)0 (0–0)<0.001
ROTEM use, n (%)123 (17.3%)58 (20.1%)65 (15.4%)0.102
Cell saver, n (%)7 (1%)4 (1.4%)3 (0.7%)0.450
Patients receiving FFP transfusion, n (%)184 (25.9%)93 (32.3%)91 (21.6%)0.001
FFP units per patient, n0 (0–2)0 (0–2)0 (0–0)0.001
Patients receiving PLT transfusion, n (%)66 (9.3%)31 (10.8%)35 (8.3%)0.266

[i] Data are reported as medians with interquartile range. Hb is reported in g/dl.

eGFR, estimated glomerular filtration rate; FFP, fresh frozen plasma; Hb, haemoglobin; ICU, intensive care unit; LOS, length of stay; PLT, platelet; PRBC, packed red blood cell; ROTEM, rotation thromboelastometry

Figure 2

Perioperative trajectory of Hb in the whole cohort, anaemic and non-anaemic patients. Values on chart represent g/dl haemoglobin at four time points – 1 at hos pital admission, 2 immediately before surgery, 3 immediately after surgery and 4 at hospital discharge. Numbers on the figure refer to Hb levels expressed as g/dl.

Hb, haemoglobin

Figure 3

Transfusion of PRBCs in non-anaemic versus anaemic patients during the perioperative period.

Table 3

Univariate and multivariate analyses of the association between perioperative variables and transfusion risk.

OR (95% CI)pOR (95% CI)p
Age1.038 (1.023–1.053)<0.0011.024 (1.0008–1.049)0.043
Female sex3.249 (2.331–4.528)<0.0013.224 (1.648–6.306)0.014
Hospital LOS1.039 (1.014–1.064)0.0021.093 (1.037–1.151)<0.001
ICU LOS1.068 (1.013–1.127)0.0151.029 (0.93–1.138)0.579
CKD (eGFR <60 ml/min)2.104 (1.013–1.127)0.0111.051 (0.365–3.027)
Surgery time (h)1.127 (1.012–1.256)0.0030.949 (0.827–1.088)0.440
Hospital death10.228 (2.38–43.959)0.002Not included in the model
Preoperative Hb <13 g/dl3.992 (2.892–5.510)<0.0013.462 (1.766–6.787)<0.001
Hb10.559 (0.496–0.630)<0.001Not included in the model
Hb20.594 (0.530–0.685)<0.001Not included in the model
Hb30.567 (0.500–0.642)<0.0010.564 (0.434–0.732)<0.001
Hb40.785 (0.691–0.891)<0.001Not included in the model
Postop bleeding ≥500 ml2.592 (1.754–3.833)<0.0012.295 (1.044–5.045)0.039
Surgical re-exploration3.469 (1.690–7.119))0.0011.132 (0.195–6.580)0.687
ROTEM use4.090 (2.590–6.457)<0.0011.568 (0.723–3.401)0.255
FFP use7.083 (4.639–10.816)<0.0015.110 (1.997–13.071)<0.001
PLT use0.169 (0.085–0.335)<0.0011.690 (0.360–7.928)0.276

[i] CI, confidence interval; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; FFP, fresh frozen plasma; Hb, haemoglobin; ICU, intensive care unit; LOS, length of stay; OR, odds ratio; PLT, platelet; ROTEM, rotation thromboelastometry

DOI: https://doi.org/10.2478/rjaic-2021-0008 | Journal eISSN: 2502-0307 | Journal ISSN: 2392-7518
Journal RSS Feed
Language: English
Page range: 47 - 56
Published on: Dec 29, 2022
Published by: Sciendo
In partnership with: Paradigm Publishing Services
Keywords:
transfusion,
anaemia,
cardiac surgery,
patient blood management
Related subjects:
Medicine,
Clinical medicine,
Clinical medicine, other,
Surgery,
Surgery, other,
Anaesthesiology,
Emergency medicine and intensive-care medicine

© 2022 Mihai Ștefan, Anca Roxana Lupu, Ștefan Andrei, Liana Văleanu, Ovidiu Știru, Cornel Robu, Teodora Bute, Bianca Moroșanu, Anamaria Dumitrescu, Alice Stegaru, Șerban Bubenek, Daniela Filipescu, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Volume 28 (2021): Issue 2 (December 2021)
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