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Ann Thorac Surg 2002;74:1180-1186
© 2002 The Society of Thoracic Surgeons
a Department of Anesthesiology, Toledo, Ohio, USA
b Department ofCardiovascular Surgery, Toledo, Ohio, USA
c St. Vincent Mercy Medical Center, Toledo, Ohio, USA
d Medical College of Ohio, Toledo, Ohio, USA
Accepted for publication May 7, 2002.
* Address reprint requests to Dr Engoren, Department of Anesthesiology, St. Vincent Mercy Medical Center, 2213 Cherry St, Toledo, OH, USA 43608
e-mail: engoren{at}pol.net
Background. Blood transfusions have been linked to increased morbidity and mortality. Bleeding during and after cardiac operations and the hemodilution effects of cardiopulmonary bypass commonly result in blood transfusions. Because we could not find any studies evaluating the effects of transfusion on long-term survival after cardiac operation, we sought to determine these effects.
Methods. We studied 1,915 patients who underwent first-time isolated coronary artery bypass operations between July 6, 1994 and December 31, 1997 at our institution. Patients with transfusions were compared with those who had not been transfused. Long-term survival data were obtained from the United States Social Security Death Index. Groups were compared by Cox proportional hazard models, Kaplan-Meier survival plots, and hazard functions.
Results. Six hundred forty-nine of 1,915 study patients (34%) received a transfusion during their hospitalization. Transfused patients were older, smaller, and more likely to be female, and had more comorbidity. Transfused patients also had twice the 5-year mortality (15% vs 7%) of nontransfused patients. After correction for comorbidities and other factors, transfusion was still associated with a 70% increase in mortality (risk ratio = 1.7; 95% confidence interval = 1.4 to 2.0; p = 0.001). By multivariate analysis, transfusion, peripheral vascular disease, chronic obstructive pulmonary disease, New York Heart Association functional class IV, and age were significant predictors of long-term mortality.
Conclusions. We found that blood transfusions during or after coronary artery bypass operations were associated with increased long-term mortality.
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|
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|
|
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|
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|
|
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|
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|
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|
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|
|
|
|
 |
|
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|
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|
|
|
|
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|
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|
|
 |
|
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|
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|
|
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|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
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|
|
 |
|
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|
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|
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|
|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 A. DeAnda Jr, K. M. Baker, S. D. Roseff, J. A. Green, H. Mccarthy, T. Aron, and B. D. Spiess Developing a blood conservation program in cardiac surgery. American Journal of Medical Quality, July 1, 2006; 21(4): 230 - 237. [Abstract] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 S Purkayastha, T Athanasiou, V Malinovski, P Tekkis, R Foale, R Casula, B Glenville, and A Darzi Does clopidogrel affect outcome after coronary artery bypass grafting? A meta-analysis. Heart, April 1, 2006; 92(4): 531 - 532. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
M. Kuduvalli, A. D. Grayson, M. J. Desmond, and B. M. Fabri Reply to Habib et al. Eur. J. Cardiothorac. Surg., September 1, 2005; 28(3): 513 - 514. [Full Text] [PDF]
|
|
|
|
|
|
J. van der Linden, G. Lindvall, and U. Sartipy Aprotinin Decreases Postoperative Bleeding and Number of Transfusions in Patients on Clopidogrel Undergoing Coronary Artery Bypass Graft Surgery: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial Circulation, August 30, 2005; 112(9_suppl): I-276 - I-280. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Habib, A. Zacharias, T. A. Schwann, C. J. Riordan, S. J. Durham, and A. Shah Effects of Obesity and Small Body Size on Operative and Long-Term Outcomes of Coronary Artery Bypass Surgery: A Propensity-Matched Analysis Ann. Thorac. Surg., June 1, 2005; 79(6): 1976 - 1986. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. H. Edwards, V. A. Ferraris, D. M. Shahian, E. Peterson, A. P. Furnary, C. K. Haan, and C. R. Bridges Gender-Specific Practice Guidelines for Coronary Artery Bypass Surgery: Perioperative Management Ann. Thorac. Surg., June 1, 2005; 79(6): 2189 - 2194. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kuduvalli, A. Y. Oo, N. Newall, A. D. Grayson, M. Jackson, M. J. Desmond, B. M. Fabri, and A. Rashid Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 592 - 598. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. I. Kapetanakis, D. A. Medlam, S. W. Boyce, E. Haile, P. C. Hill, M. K.C. Dullum, A. S. Bafi, K. R. Petro, and P. J. Corso Clopidogrel administration prior to coronary artery bypass grafting surgery: the cardiologist's panacea or the surgeon's headache? Eur. Heart J., March 2, 2005; 26(6): 576 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Shander, D. Moskowitz, and T. S. Rijhwani The Safety and Efficacy of "Bloodless" Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 53 - 63. [Abstract] [PDF]
|
|
|
|
|
|
T. L. Frankel, S. C. Stamou, R. C. Lowery, E. I. Kapetanakis, P. C. Hill, E. Haile, and P. J. Corso Risk factors for hemorrhage-related reexploration and blood transfusion after conventional versus coronary revascularization without cardiopulmonary bypass Eur. J. Cardiothorac. Surg., March 1, 2005; 27(3): 494 - 500. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Diprose, M. J. Herbertson, D. O'Shaughnessy, C. D. Deakin, and R. S. Gill Reducing allogeneic transfusion in cardiac surgery: a randomized double-blind placebo-controlled trial of antifibrinolytic therapies used in addition to intra-operative cell salvage Br. J. Anaesth., March 1, 2005; 94(3): 271 - 278. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A Sobieski II, M. S Slaughter, D. E Hart, P. S Pappas, and A. J Tatooles Prospective study on cardiopulmonary bypass prime reduction and its effect on intraoperative blood product and hemoconcentrator use Perfusion, January 1, 2005; 20(1): 31 - 37. [Abstract] [PDF]
|
|
|
|
|
|
B. D. Spiess Transfusion of Blood Products Affects Outcome in Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2004; 8(4): 267 - 281. [Abstract] [PDF]
|
|
|
|
|
|
M. Ando, Y. Takahashi, and N. Suzuki Open Heart Surgery for Small Children Without Homologous Blood Transfusion by Using Remote Pump Head System Ann. Thorac. Surg., November 1, 2004; 78(5): 1717 - 1722. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Chen, A. W. Bracey, R. Radovancevic, J. R. Cooper Jr, C. D. Collard, W. K. Vaughn, and N. A. Nussmeier Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., September 1, 2004; 128(3): 425 - 431. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R de Vroege, F te Meerman, L Eijsman, W R Wildevuur, C. R. Wildevuur, and W van Oeveren Induction and detection of disturbed homeostasis in cardiopulmonary bypass Perfusion, September 1, 2004; 19(5): 267 - 276. [Abstract] [PDF]
|
|
|
|
|
|
J. J. Andreasen and C. Nielsen Prophylactic tranexamic acid in elective, primary coronary artery bypass surgery using cardiopulmonary bypass Eur. J. Cardiothorac. Surg., August 1, 2004; 26(2): 311 - 317. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. T. Hare, K. M. Hum, S. Y. Kim, A. Barr, A. J. Baker, and C. D. Mazer Increased Cerebral Tissue Oxygen Tension After Extensive Hemodilution with a Hemoglobin-Based Oxygen Carrier Anesth. Analg., August 1, 2004; 99(2): 528 - 535. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. S. Donahue Factor V Leiden and Perioperative Risk Anesth. Analg., June 1, 2004; 98(6): 1623 - 1634. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Ootaki, M. Yamaguchi, N. Yoshimura, S. Oka, M. Yoshida, and T. Hasegawa Efficacy of a criterion-driven transfusion protocol in patients having pediatric cardiac surgery J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 953 - 958. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Toraman, S. Evrenkaya, M. Yuce, O. Turek, N. Aksoy, H. Karabulut, O. Demirhisar, and C. Alhan Highly positive intraoperative fluid balance during cardiac surgery is associated with adverse outcome Perfusion, March 1, 2004; 19(2): 85 - 91. [Abstract] [PDF]
|
|
|
|
 |
|
 C Nielson and D Wingete Intensive care and invasive ventilation in the elderly patient, implications of chronic lung disease and comorbidities Chronic Respiratory Disease, January 1, 2004; 1(1): 43 - 54. [Abstract] [PDF]
|
|
|
|
|
|
