Ann Thorac Surg 2003;76:654
© 2003 The Society of Thoracic Surgeons
Correspondence
Counter-intuitive results from nonrandomized trials may unmask the "Art of Medicine"
George C. Robinson, MDa
a 300 Medical Center Dr, Suite 103, Gadsden, AL 35903, USA
e-mail: gcrob{at}bellsouth.net
To the Editor:
Although the nonrandomized study by Engoren and associates [1] demonstrates some adverse effects from transfusion, it probably also shows that a clinician’s judgment about when a transfusion is needed for a sicker patient is better than risk factors on paper can estimate. A few years ago, a nonrandomized study indicated that Swan-Ganz catheters were associated with more morbidity, but this, too, showed that the art of medicine was alive and well. A good clinician’s judgment about the patient’s degree of illness is far better than any post–ipso facto morbidity factor matching.
In my institutions, elderly patients with a hematocrit of less than 30% had a poorer outcome, a finding suggesting the need of transfusion in elderly, sicker patients.
References
- Engoren M.C., Habib R.H., Zacharias A., Schwann T.A., Riordan C.J., Durham S.J. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 2002;74:1180-1186.[Abstract/Free Full Text]
