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Ann Thorac Surg 2004;77:626-634
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center

^a Department of Anesthesiology and Critical Care Medicine, Englewood, New Jersey, USA
^b Department of Cardiothoracic Surgery, Englewood, New Jersey, USA
^c Division of Cardiology, Department of Internal Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, USA
^d Department of Biomathematical Sciences, Mount Sinai Medical Center, New York, New York, USA

Accepted for publication July 10, 2003.

^* Address reprint requests to Dr Moskowitz, Director, Cardiothoracic Anesthesia, Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA.
e-mail: david.moskowitz{at}ehmc.com

BACKGROUND: Previous studies defining perioperative risk factors for allogeneic transfusion requirements in cardiac surgery were limited to highly selected cardiac surgery populations or were associated with high transfusion rates. The purpose of this study was to determine perioperative risk factors and create a formula to predict transfusion requirements for major cardiac surgical procedures in a center that practices a multimodality approach to blood conservation.

METHODS: We performed an observational study on 307 consecutive patients undergoing coronary artery bypass grafting, valve, and combined (coronary artery bypass grafting and valve) procedures. An equation was derived to estimate the risk of transfusion based on preoperative risk factors using multivariate analysis. In patients with a calculated probability of transfusion of at least 5%, intraoperative predictors of transfusion were identified by multivariate analysis.

RESULTS: Thirty-five patients (11%) required intraoperative or postoperative allogeneic transfusions. Preoperative factors as independent predictors for transfusions included red blood cell mass, type of operation, urgency of operation, number of diseased vessels, serum creatinine of at least 1.3 mg/dL, and preoperative prothrombin time. Intraoperative factors included cardiopulmonary bypass time, three or fewer bypass grafts, lesser volume of acute normovolemic hemodilution removed, and total crystalloid infusion of at least 2,500 mL. The derived formula was applied to a validation cohort of 246 patients, and the observed transfusion rates conformed well to the predicted risks.

CONCLUSIONS: A multimodality approach to blood conservation in cardiac surgery resulted in a low transfusion rate. Identifying patients' risks for transfusion should alter patient management perioperatively to decrease their transfusion rate and make more efficient use of blood resources.

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