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ORIGINAL ARTICLE Table of Contents   
Year : 2008  |  Volume : 11  |  Issue : 1  |  Page : 15-19
Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery


Departments of Anesthesiology and Surgery, SUNY at Stony Brook, New York, USA

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   Abstract 

The purpose of the present investigation was to examine the impact of blood transfusion on resource utilisation, morbidity and mortality in patients undergoing coronary artery bypass graft (CABG) surgery at a major university hospital. The resources we examined are time to extubation, intensive care unit length of stay (ICULOS) and postoperative length of stay (PLOS). We further examined the impact of number of units of packed red blood cells (PRBCs) transfused during PLOS.
This is a retrospective observational study and includes 1746 consecutive male and female patients undergoing primary CABG (on- and off-pump) at our institution. Of these, 1067 patients received blood transfusions, while 677 did not. The data regarding the demography, blood transfusion, resource utilisation, morbidity and mortality were collected from the records of patients undergoing CABG over a period of three years. The mean time to extubation following surgery was 8.0 h for the transfused group and 4.3 h for the nontransfused group ( P ≤ 0.001). The mean ICULOS for the transfused group was 1.6 d and 1.2 d for the nontransfused group ( P < 0.001). The PLOS was 7.2 d for the transfused group and 4.3 d for no-transfused cohorts ( P ≤ 0.001). In all patients and in patients with no preoperative morbidity, partial correlation coefficients were used to examine the effects of transfusion on mortality, time to extubation, ICULOS and PLOS. Linear regression model was used to assess the effect of number of PRBC units transfused on PLOS. We noted that PLOS increased with the number of PRBCs units transfused. Transfusion is significantly correlated with the increased time to extubation, ICULOS, PLOS and mortality. The transfused patients had significantly more postoperative complications than their nontransfused counterparts ( P ≤ 0.001). The 30-day hospital mortality was 3.1% for the transfused group with no deaths in the nontransfused group ( P ≤ 0.001).
We conclude that the CABG patients receiving blood transfusion have significantly longer time for tracheal extubation, ICULOS, PLOS and higher morbidity and 30-day hospital mortality. Blood transfusion was an independent predictor of increased resource utilisation, postoperative morbidity and mortality.

Keywords: Coronary artery bypass grafting, mortality, resource utilisation, transfusion

How to cite this article:
Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth 2008;11:15-9

How to cite this URL:
Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth [serial online] 2008 [cited 2016 Aug 25];11:15-9. Available from: http://www.annals.in/text.asp?2008/11/1/15/38444



   Introduction Top


Blood transfusion is common in patients undergoing coronary artery bypass graft (CABG) surgery. Approximately 20% of the available blood supply in the United States is consumed by patients undergoing cardiac surgery. [1] It is expected that with the increase in age and comorbidities among patients presenting for surgery, blood transfusion will further increase. [2] Despite this, there is a relatively scant information with regard to the impact of transfusion on resource utilisation and postoperative morbidity and mortality. The goal of our investigation was to examine the impact of transfusion on the duration of intubation, intensive care unit length of stay (ICULOS), postoperative length of stay (PLOS), morbidity and mortality in patients undergoing CABG surgery. We also examined the relation between the number of units of packed red blood cells (PRBCs) transfused and PLOS in this group of patients.


   Materials and Methods Top


This study was approved by the institutional review board for collecting data from the patient's medical records. This is a retrospective observational study. The study population included all patients undergoing primary CABG at a tertiary care heart centre over a period of three years. There were a total of 1746 patients. All patients underwent CABG surgery through a median sternotomy incision. Aspirin was discontinued 7 d prior to elective surgery.

One day before surgery, the patients in the hospital were premedicated with morphine and scopolamine prior to their arrival in the operating room. Patients arriving on the day of surgery were premedicated with midazolam as deemed appropriate by the anaesthesiologist. Intraoperative monitors included the standard American Society of Anesthesiologists monitors along with 5-lead electrocardiogram with continuous automated ST segment analysis, continuous arterial pressure determination using a radial artery catheter and a pulmonary artery catheter. All patients received standard fast-track anaesthetic induction using a combination of 5-10 µg/kg fentanyl and 0.05-0.1 mg/kg midazolam. We used 0.1 mg/kg vecuronium or 1 mg/kg rocuronium for neuromuscular blockade. Anaesthesia was maintained with supplements of propofol, isoflurane or sevoflurane as deemed appropriate by the anaesthesiologist. Patients undergoing CABG under CPB received 300 units/kg of heparin, and the activated clotting time (ACT) was maintained above 400 s prior to institution of cardiopulmonary bypass. Patients undergoing off-pump coronary artery bypass (OPCAB) received 100 to 200 units/kg of heparin to maintain the ACT above 350 s. Both groups received additional heparin as deemed necessary to maintain the ACT at the desired levels. The left internal mammary artery was harvested as surgically indicated and the saphenous vein was used for additional conduits. Patients undergoing CABG under cardiopulmonary bypass (CPB) were cannulated with an aortic cannula and a two-stage venous cannula prior to institution of cardiopulmonary bypass. Membrane oxygenators were used in all patients. Both retrograde and antegrade intermittent cold (6 °C) blood cardioplegia solution was administered for myocardial protection. Systemic temperature was permitted to maintain at 30-32 °C during cardiopulmonary bypass. All distal and proximal anastomoses were constructed using a single cross-clamp technique. In patients undergoing OPCAB, special off-pump coronary retractors and stabilisers were utilised during distal coronary anastomosis (Guidant, Indianapolis, IN). Proximal anastomoses were constructed using multiple cross-clamp technique. All patients were actively rewarmed to 37 °C prior to weaning from CPB. All patients undergoing CABG under CPB received epsilon aminocaproic acid during surgery. No antifibrinolytics were used in the OPCAB patients. The guidelines we followed for blood transfusion was triggered by the hematocrit values, ventricular function and other associated comorbidities. The end points of blood transfusion were to maintain a hematocrit value over 25% in patients with normal haemodynamics and ventricular function and over 30% in patients with compromised haemodynamics and ventricular function. These guidelines applied to all patients.

All demographic and clinical data were collected on the standardized data collection forms as required by the New York State cardiac surgical reporting system for predicting the risk-adjusted mortality rate according to the New York State department of health. This included age, gender, weight, body surface area (BSA), use of intraaortic balloon pump, left ventricular ejection fraction, use of cardiopulmonary bypass pump, number of distal coronary grafts, comorbid conditions such as diabetes, hypertension, congestive heart failure (CHF), renal failure, chronic obstructive pulmonary disease (COPD), previous myocardial infarction and postoperative bleeding requiring reoperation. The data pertaining to pre- and post-operative hematocrit values, the time to postoperative tracheal extubation, PRBC transfusion, ICULOS, PLOS and mortality and morbidity were obtained from the medical records of the patients. Extubation time is defined as the time from leaving the operating room to the removal of the endotracheal tube. ICULOS is defined as the time of admission to the ICU until the time of discharge to the intermediate care or step down unit. PLOS is defined as the time from the day of surgery until the day of discharge from the hospital. All patients were assessed for extubation within the first hour of arrival in the ICU and placed on our standard extubation protocol. The data pertaining to postoperative complications such as stroke, renal failure and 30-day mortality were also collected.

Statistical methods

Data are summarized and described using means, standard deviations and proportions. The demographic, clinical and outcome variables were compared between the transfused and nontransfused patients using the Wilcoxon rank sum test. The P values for these comparisons are reported. A P value of <0.05 was considered significant. Partial correlation coefficients and linear and logistic regression analysis were used for assessing the relations between the key outcome variables and clinical correlates. All the values have been expressed as mean ± standard deviation (SD).


   Results Top


The demographic and clinical data are presented in [Table - 1]. A total of 1746 patients participated in this study. Of the 1746 patients, 1069 received blood transfusion, while 677 did not. The number of females was significantly higher in the transfused group; these patients were significantly older in age, smaller in size with slightly lower ejection fractions. Transfused patients demonstrated significantly lower pre- and postoperative hematocrit values. Moreover, significantly higher incidence of preoperative hypertension, diabetes, myocardial infarction, renal insufficiency, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) and peripheral vascular disease (PVD). They also exhibited a higher incidence of mammary artery usage and postoperative bleeding requiring reexploration. The transfused patients demonstrated a significantly higher incidence of postoperative renal failure, neurological complications, infection and mortality. No deaths occurred among the patients of the nontransfused group as compared to 3.1% among the transfused group. These data are displayed in [Table - 2]. The mean time for tracheal extubation was 8.0 h for the transfused group and 4.3 h for the nontransfused group ( P < 0.001). The transfused group also had significantly more patients who required >72 h of mechanical ventilation ( P < 0.001). The mean ICULOS was 1.6 versus 1.2 d for the nontransfused group ( P < 0.001). The mean PLOS was 7.2 d for the transfused group and 4.2 d for the nontransfused group ( P < 0.001). Resource utilisation and mortality data are displayed in [Table - 3]. The P values for partial correlation coefficients between transfusion and time to extubation, ICULOS, PLOS and mortality were <0.001. We further examined the correlation between transfusion and time to extubation, ICULOS and PLOS in patients with no prior illness and found the P values to be <0.05. Partial correlations were adjusted for the effects of age, sex and body surface area (BSA). These results are displayed in [Table - 4],[Table - 5]. Linear regression model was used to examine the impact of the number of units of PRBCs transfused on PLOS in all patients and in patients with no prior comorbidities. These results are shown in [Figure - 1],[Figure - 2].


   Discussion Top


The goal of the present investigation was to examine the impact of blood transfusion on resource utilisation, morbidity and mortality in patients undergoing elective CABG surgery in our tertiary care heart center. The resources examined were time to extubation, ICULOS and PLOS. The significant findings of this study are that the transfused patients remained intubated for prolonged duration and had significantly longer ICULOS and PLOS as compared to their nontransfused counterparts. The transfused patients also had higher incidence of postoperative neurological and gastrointestinal (GI) complications, renal failure and infection. They also exhibited a higher incidence of postoperative bleeding requiring reexploration. The transfused patients had significantly higher incidence of 30-day mortality as compared to their nontransfused cohorts.

The first resource we examined was the duration of intubation and mechanical ventilation after surgery. Our results showed that the transfused patients were intubated for significantly longer time as compared to nontransfused patients. This data is in agreement with previously published reports. [3],[4] Our data also showed that 3.6% of the transfused patients remained intubated for longer than 72 h; however, in the nontransfused group, no patient remained intubated for longer than 72 h. This is an important utilisation factor because early tracheal extubation has been shown to decrease the cost of surgery. [5] We examined ICULOS as the subsequent resource. We believe that this resource generally follows a trend similar to the time to extubation. Our data shows that the transfused patients had significantly longer ICULOS similar to that in extubation. This fact is in agreement with those from previous reports. [3],[4],[5],[6],[7] With regard to PLOS, the transfused patients had significantly longer PLOS as compared to their nontransfused cohorts. Our results are in agreement with those of previous reports. [3],[6],[7] Our study shows that the incidence of postoperative complications was significantly higher in the transfused group. They had a significantly higher incidence of postoperative renal failure, stroke, infection and GI complications [3],[8],[9] and were reexplored for postoperative bleeding more often. This data is in agreement with previously reported studies. [8],[10] We examined the 30-day mortality and found that patients who received blood transfusion had significantly higher incidence of 30-day mortality. No deaths occurred in the nontransfused group. Previous studies have examined mortality in the transfused CABG patients and a majority of these reports have documented the deleterious effects of transfusion on long-term mortality. Our results are in agreement with those of previous studies. [7],[8],[10],[11],[12] We further examined the relationship between the number of units of PRBCs transfused and PLOS. We found that PLOS increased as the number of units of blood administered increased in a linear fashion. The length of stay increased by approximately 0.82 d for every unit of blood transfused. This is in agreement with a previously published report examining the relation between PLOS and number of units of PRBCs transfused. [6]

It is important to note that our transfused patients were older, smaller and had lower preoperative hematocrit values. The transfused group comprised significantly more females. All these are the known risk factors for transfusion. [2],[13],[14] The transfused group also had significantly more preoperative comorbidities. They had a significantly higher incidence of preoperative diabetes, hypertension, renal failure, CHF, COPD and PVD. They also had a lower preoperative hematocrit value. This is similar to what has been reported in previous studies. [8],[10] The question is "is it the higher incidence of preoperative comorbidities that is responsible for the increased incidence of postoperative morbidity and mortality or is transfusion a marker for the severity of illness." Our analysis shows that transfusion is an independent predictor of increased resource utilisation because even in patients with no preoperative morbidities, transfusion correlated with increased duration of intubation, ICULOS and PLOS. Among these patients, PLOS increased with the number of units of PRBCs transfused. Some of the previous reports have encountered the same question and have concluded that transfusion is an independent predictor of early and late mortality and increased ICULOS and PLOS. [3],[4],[6] Our results are in agreement with these previous reports.

In conclusion, our data show that patients who received transfusion had significantly longer time to extubation, ICULOS and PLOS. They also had significantly higher incidence of the 30-day mortality. We found that PLOS increased with the number of units of PRBCs transfused.

 
   References Top

1.Spiess BD. Transfusion and outcome in heart surgery. Ann Thorac Surg 2002;74:986-7.  Back to cited text no. 1    
2.Scott B, Seifert FC, Glass PS, Grimson R. Blood utilization in patients undergoing coronary artery bypass surgery: Impact of cardiopulmonary bypass pump, Hematocrit, Gender, Age and Body weight. Anesth Analg 2003;97:958-63.  Back to cited text no. 2    
3.Leal-Noval SR, Jara-Lopez I, Garcia-Garmendia JL, Marνn-Niebla A, Herruzo-Avilιs A, Camacho-Laraρa P, et al. Influnce of erythrocyte concentrate storage time on post surgical morbidity in cardiac surgery patients. Anesthesiology 2003;98:815-22.  Back to cited text no. 3    
4.Habib RH, Zacharias A, Engoren M. Determinants of prolonged mechanical ventilation after coronary artery bypass grafting. Ann Thorac Surg 1996;62:1164-71.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Cheng DC. Fast track cardiac surgery: Economic implications in postoperative care. J Cardiothorac Vasc Anesth 1998;12:72-9.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Vamkas EC, Carven JH. RBC transfusion and postoperative length of stay in the hospital or the intensive care unit among patients undergoing coronary artery bypass graft surgery: The effects of confounding factors. Transfusion 2000;40:832-9.  Back to cited text no. 6    
7.Basran S, Frumento RJ, Cohen A, Lee S, Du Y, Nishanian E, et al. The association between duration of storage of transfused red blood cells and morbidity and mortality after reoperative cardiac surgery. Anesth Analg 2006;103:15-20.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Kuduvalli M, Oo AY, Newall N, Grayson AD, Jackson M, Desmond MJ, et al. Effect of perioperative red blood cell transfusion on 30 day and 1 year mortality following coronary artery bypass surgery. Eur J Cardiothorac Surg 2005;27:592-8.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Fransen E, Maessen J, Dentener M, Senden N, Buurman W. Impact of blood transfusion on inflammatory mediator release in patients undergoing cardiac surgery. Chest 1999;116:1233-9.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. Effect of blood transfusion on long term survival after cardiac operation. Ann Thorac Surg 2002;74:1180-6.  Back to cited text no. 10  [PUBMED]  
11.Koch G, Li L, Duncan AI, Mihaljevic T, Loop FD, Starr NJ, Blackstone EH. Transfusion in coronary artery bypass grafting is associated with reduced long term survival. Ann Thorac Surg 2006;81:1650-7.  Back to cited text no. 11    
12.Bracey AW, Radovancevic R, Riggs SA, Houston S, Cozart H, Vaughn WK, et al. Lowering the haemoglobin threshold for transfusion in coronary artery bypass procedures: Effect on patient outcome. Transfusion 1999;39:1070-7.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Parr KG, Patel MA, Dekker R, Levin R, Glynn R, Avorn J, et al. Multivariate predictors of blood product use in cardiac surgery. J Cardiothorac Vasc Anesth 2003;17:176-81.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.Utley JR, Wilde EF, Leyland SA, Morgan MS, Johnson HD. Intra-operative blood transfusion is a major risk factor for coronary artery bypass grafting. Ann Thorac Surg 1995;60:570-5.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Bharathi H Scott
Department of Anesthesiology, SUNY at Stony Brook Health Sciences Center, L4-060 Stony Brook, NY 11794-8480
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.38444

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31 Blood product conservation is associated with improved outcomes and reduced costs after cardiac surgery
Lapar, D.J. and Crosby, I.K. and Ailawadi, G. and Ad, N. and Choi, E. and Spiess, B.D. and Rich, J.B. and Kasirajan, V. and Fonner Jr., E. and Kron, I.L. and Speir, A.M.
Journal of Thoracic and Cardiovascular Surgery. 2013; 145(3): 796-804
[Pubmed]
32 Variation of blood transfusion in patients undergoing major noncardiac surgery
Qian, F. and Osler, T.M. and Eaton, M.P. and Dick, A.W. and Hohmann, S.F. and Lustik, S.J. and Diachun, C.A. and Pasternak, R. and Wissler, R.N. and Glance, L.G.
Annals of Surgery. 2013; 257(2): 266-278
[Pubmed]
33 Transfusion of cell saver salvaged blood in neonates and infants undergoing open heart surgery significantly reduces RBC and coagulant product transfusions and donor exposures: Results of a prospective, randomized, clinical trial
Cholette, J.M. and Powers, K.S. and Alfieris, G.M. and Angona, R. and Henrichs, K.F. and Masel, D. and Swartz, M.F. and Daugherty, L.E. and Belmont, K. and Blumberg, N.
Pediatric Critical Care Medicine. 2013; 14(2): 137-147
[Pubmed]
34 Putting the record straight on aprotinin as safe and effective: Results from a mixed treatment meta-analysis of trials of aprotinin
Howell, N. and Senanayake, E. and Freemantle, N. and Pagano, D.
Journal of Thoracic and Cardiovascular Surgery. 2013; 145(1): 234-240
[Pubmed]
35 Facts, opinions, and conclusions: Aprotinin brings out all of these
Ferraris, V.A.
Journal of Thoracic and Cardiovascular Surgery. 2013; 145(1): 240-242
[Pubmed]
36 The Impact of Perioperative Packed Red Blood Cell Transfusion on Survival in Epithelial Ovarian Cancer
Lindsay L. Morgenstern Warner,Sean C. Dowdy,Janice R. Martin,Maureen A. Lemens,Michaela E. McGree,Amy L. Weaver,Karl C. Podratz,Jamie N. Bakkum-Gamez
International Journal of Gynecological Cancer. 2013; 23(9): 1612
[Pubmed] | [DOI]
37 Novel Ultrafiltration Technique for Blood Conservation in Cardiac Operations
Serdar Gunaydin,Terence Gourlay
The Annals of Thoracic Surgery. 2013; 95(6): 2148
[Pubmed] | [DOI]
38 Facts, opinions, and conclusions: Aprotinin brings out all of these
Victor A. Ferraris
The Journal of Thoracic and Cardiovascular Surgery. 2013; 145(1): 240
[Pubmed] | [DOI]
39 Transfusion of Cell Saver Salvaged Blood in Neonates and Infants Undergoing Open Heart Surgery Significantly Reduces RBC and Coagulant Product Transfusions and Donor Exposures
Jill M. Cholette,Karen S. Powers,George M. Alfieris,Ronald Angona,Kelly F. Henrichs,Debra Masel,Michael F. Swartz,L. Eugene Daugherty,Kevin Belmont,Neil Blumberg
Pediatric Critical Care Medicine. 2013; 14(2): 137
[Pubmed] | [DOI]
40 Impact of Minimized Extracorporeal Circulation on Outcome in Patients With Preoperative Anemia Undergoing Coronary Artery Bypass Surgery
Assad Haneya,Alois Philipp,Marietta Von Suesskind-Schwendi,Claudius Diez,Stephan W. Hirt,Philipp Kolat,Tim Attmann,Jan Schoettler,York Zausig,Michael Ried,Christof Schmid
ASAIO Journal. 2013; 59(3): 269
[Pubmed] | [DOI]
41 Putting the record straight on aprotinin as safe and effective: Results from a mixed treatment meta-analysis of trials of aprotinin
Neil Howell,Eshan Senanayake,Nick Freemantle,Domenico Pagano
The Journal of Thoracic and Cardiovascular Surgery. 2013; 145(1): 234
[Pubmed] | [DOI]
42 Blood conservation strategies reduce the need for transfusions in ascending and aortic arch surgery
Chu, M.W.A. and Losenno, K.L. and Moore, K. and Berta, D. and Hewitt, J. and Ralley, F.
Perfusion (United Kingdom). 2013; 28(4): 315-321
[Pubmed]
43 Over the next hill
Emery, R.W. and Cooper, M.M. and Joyce, D.L.
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2012; 7(3): 165-172
[Pubmed]
44 A randomized controlled pilot study of adherence to transfusion strategies in cardiac surgery
Shehata, N. and Burns, L.A. and Nathan, H. and Hebert, P. and Hare, G.M.T. and Fergusson, D. and Mazer, C.D.
Transfusion. 2012; 52(1): 91-99
[Pubmed]
45 Percutaneous Treatment of Mitral Regurgitation: The MitraClip Experience
Alice Perlowski, Ted Feldman
Interventional Cardiology Clinics. 2012; 1(1): 63
[VIEW] | [DOI]
46 Impact of major bleeding and blood transfusions after cardiac surgery: Analysis from the Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial
Gregg W. Stone,Tim C. Clayton,Roxana Mehran,George Dangas,Helen Parise,Martin Fahy,Stuart J. Pocock
American Heart Journal. 2012; 163(3): 522
[Pubmed] | [DOI]
47 Niveles de hemoglobina preoperatorios y desenlaces en los pacientes llevados a cirugía cardiovascular, revisión sistemática y metaanálisis
Henry Oliveros Rodríguez,Édgar Beltrán Linares
Revista Colombiana de Anestesiología. 2012; 40(1): 27
[Pubmed] | [DOI]
48 Preoperative Hemoglobin Levels and Outcomes in Cardiovascular Surgical Patients; systematic review and meta-analysis
Henry Oliveros,Édgar Beltrán Linares
Colombian Journal of Anesthesiology. 2012; 40(1): 27
[Pubmed] | [DOI]
49 Tranexamic acid reduces blood loss after off-pump coronary surgery: A prospective, randomized, double-blind, placebo-controlled study
Wang, G. and Xie, G. and Jiang, T. and Wang, Y. and Wang, W. and Ji, H. and Liu, M. and Chen, L. and Li, L.
Anesthesia and Analgesia. 2012; 115(2): 239-243
[Pubmed]
50 Variability in transfusion practice and effectiveness of strategies to improve it
Shander, A. and Puzio, T. and Javidroozi, M.
Journal of Cardiothoracic and Vascular Anesthesia. 2012; 26(4): 541-544
[Pubmed]
51 Clinical benefits and cost-effectiveness of allogeneic red-blood-cell transfusion in severe symptomatic anaemia
Beliaev, A.M. and Marshall, R.J. and Gordon, M. and Smith, W. and Windsor, J.A.
Vox Sanguinis. 2012; 103(1): 18-24
[Pubmed]
52 Successful coronary artery bypass grafting with the aid of a portable minimized extracorporeal life support system
Haneya, A. and Philipp, A. and Camboni, D. and Fabricius, A. and Diez, C. and Kobuch, R. and Hirt, S.W. and Keyser, A. and Rupprecht, L. and Hilker, M. and Schmid, C. and Puehler, T.
ASAIO Journal. 2012; 58(4): 337-342
[Pubmed]
53 Impact of major bleeding and blood transfusions after cardiac surgery: Analysis from the acute catheterization and urgent intervention triage strategy (ACUITY) trial
Stone, G.W. and Clayton, T.C. and Mehran, R. and Dangas, G. and Parise, H. and Fahy, M. and Pocock, S.J.
American Heart Journal. 2012; 163(3): 522-529
[Pubmed]
54 Preoperative hemoglobin levels and outcomes in cardiovascular surgical patients; Systematic review and meta-analysis [Niveles de hemoglobina preoperatorios y desenlaces en los pacientes llevados a cirugía cardiovascular, revision sistemática y metaanálisis]
Rodríguez, H.O. and Linaresb, E.B.
Revista Colombiana de Anestesiologia. 2012; 40(1): 27-33
[Pubmed]
55 Percutanenous Therapies for Mitral Regurgitation
Alice Perlowski, Frederick St. Goar, Donald G. Glower, Ted Feldman
Current Problems in Cardiology. 2012; 37(2): 42
[VIEW] | [DOI]
56 Tranexamic Acid Reduces Blood Loss After Off-Pump Coronary Surgery
Guyan Wang,Gaoqiang Xie,Tingting Jiang,Yuefu Wang,Weipeng Wang,Hongwen Ji,Mingzheng Liu,Lei Chen,Lihuan Li
Anesthesia & Analgesia. 2012; 115(2): 239
[Pubmed] | [DOI]
57 Variability in Transfusion Practice and Effectiveness of Strategies to Improve It
Aryeh Shander,Thomas Puzio,Mazyar Javidroozi
Journal of Cardiothoracic and Vascular Anesthesia. 2012; 26(4): 541
[Pubmed] | [DOI]
58 Clinical benefits and cost-effectiveness of allogeneic red-blood-cell transfusion in severe symptomatic anaemia : Allogeneic red-blood-cell transfusion in severe anaemia
A. M. Beliaev, R. J. Marshall, M. Gordon, W. Smith, J. A. Windsor
Vox Sanguinis. 2011; : no
[VIEW] | [DOI]
59 Effect of the use of fresh frozen plasma in cardiac surgery on the postoperative serum creatinine values
Gökalp, O. and Kestelli, M. and Yürekli, I. and Beşir, Y. and Yilik, L. and Yaşa, H. and Yetkin, U. and Gürbüz, A.
Turkish Journal of Thoracic and Cardiovascular Surgery. 2011; 19(4): 490-494
[Pubmed]
60 Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery
Yoo, Y.-C. and Shim, J.-K. and Kim, J.-C. and Jo, Y.-Y. and Lee, J.-H. and Kwak, Y.-L.
Anesthesiology. 2011; 115(5): 929-937
[Pubmed]
61 Coronary artery bypass grafting in patients with type 2 diabetes mellitus: A comparison between minimized and conventional extracorporeal circulation
Haneya, A. and Puehler, T. and Philipp, A. and Diez, C. and Ried, M. and Kobuch, R. and Hirt, S.W. and Metterlein, T. and Schmid, C. and Lehle, K.
ASAIO Journal. 2011; 57(6): 501-506
[Pubmed]
62 Effect of body mass index on postoperative transfusions and 24-hour chest-tube output
Nolan, H.R. and Ramaiah, C.
International Journal of Angiology. 2011; 20(2): 81-85
[Pubmed]
63 Perioperative blood conservation strategies in pediatric patients undergoing open-heart surgery: Impact of non-autologous blood transfusion and surface-coated extracorporeal circuits
Gunaydin, S. and McCusker, K. and Vijay, V.
Perfusion. 2011; 26(3): 199-205
[Pubmed]
64 Minimized extracorporeal circulation system in coronary artery bypass surgery: A 10-year single-center experience with 2243 patients
Puehler, T. and Haneya, A. and Philipp, A. and Zausig, Y.A. and Kobuch, R. and Diez, C. and Birnbaum, D.E. and Schmid, C.
European Journal of Cardio-thoracic Surgery. 2011; 39(4): 459-464
[Pubmed]
65 The team focus on improving blood transfusion
McMillan, D. and Brady, P. and Foot, C. and Levy, R. and Thomson, A.
Journal of Extra-Corporeal Technology. 2011; 43(1): P65-P67
[Pubmed]
66 Storage time of allogeneic red blood cells is associated with risk of severe postoperative infection after coronary artery bypass grafting
Andreasen, J.J. and Dethlefsen, C. and Modrau, I.S. and Baech, J. and Schonheyder, H.C. and Moeller, J.K. and Johnsen, S.P.
European Journal of Cardio-thoracic Surgery. 2011; 39(3): 329-334
[Pubmed]
67 The influence of an ageing population on care and clinical resource utilisation in cardiac surgery
Ngaage, D.L. and Britchford, G. and Cale, A.R.J.
British Journal of Cardiology. 2011; 18(1): 28-32
[Pubmed]
68 Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients
Patrick Möhnle, Stephanie A. Snyder-Ramos, Yinghui Miao, Alexander Kulier, Bernd W. Böttiger, Jack Levin, Dennis T. Mangano
Intensive Care Medicine. 2011; 37(1): 97
[VIEW] | [DOI]
69 A randomized controlled pilot study of adherence to transfusion strategies in cardiac surgery : ADHERENCE TO TRANSFUSION CRITERIA
Nadine Shehata, Laura Alexandra Burns, Howard Nathan, Paul Hebert, Gregory M.T. Hare, Dean Fergusson, C. David Mazer
Transfusion. 2011; : no
[VIEW] | [DOI]
70 Update on Blood Conservation for Cardiac Surgery
Bhanu P. Nalla, John Freedman, Gregory M.T. Hare, C. David Mazer
Journal of Cardiothoracic and Vascular Anesthesia. 2011;
[VIEW] | [DOI]
71 Is chronic obstructive pulmonary disease an independent risk factor for transfusion in coronary artery bypass graft surgery?
Lacey M. Stelle, Theresa M. Boley, Stephen J. Markwell, Stephen R. Hazelrigg, Christina M. Vassileva
European Journal of Cardio-Thoracic Surgery. 2011;
[VIEW] | [DOI]
72 Effect of Single Recombinant Human Erythropoietin Injection on Transfusion Requirements in Preoperatively Anemic Patients Undergoing Valvular Heart Surgery :
Young-Chul Yoo, Jae-Kwang Shim, Jong-Chan Kim, Youn-Yi Jo, Jong-Hoon Lee, Young-Lan Kwak
Anesthesiology. 2011; 115(5): 929
[VIEW] | [DOI]
73 Patient blood management during cardiac surgery: Do we have enough evidence for clinical practice?
Journal of Thoracic and Cardiovascular Surgery. 2011;
[VIEW] | [DOI]
74 Coronary Artery Bypass Grafting in Patients With Type 2 Diabetes Mellitus: A Comparison Between Minimized and Conventional Extracorporeal Circulation :
Assad Haneya, Thomas Puehler, Alois Philipp, Claudius Diez, Michael Ried, Reinhard Kobuch, Stephan W. Hirt, Thomas Metterlein, Christof Schmid, Karla Lehle
ASAIO Journal. 2011; 57(6): 501
[VIEW] | [DOI]
75 The cost and consequences of proximal femoral fractures which require further surgery following initial fixation
Thakar, C., Alsousou, J., Hamilton, T.W., Willett, K.
Journal of Bone and Joint Surgery - Series B. 2010; 92(12): 1669-1677
[Pubmed]
76 Variation in use of blood transfusion in coronary artery bypass graft surgery
Bennett-Guerrero, E., Zhao, Y., OæBrien, S.M., Ferguson Jr., T.B., Peterson, E.D., Gammie, J.S., Song, H.K.
JAMA - Journal of the American Medical Association. 2010; 304(14): 1568-1575
[Pubmed]
77 Transfusion requirements after cardiac surgery: The TRACS randomized controlled trial
Hajjar, L.A., Vincent, J.-L., Galas, F.R.B.G., Nakamura, R.E., Silva, C.M.P., Santos, M.H., Fukushima, J., (...), Auler Jr., J.O.C.
JAMA - Journal of the American Medical Association. 2010; 304(14): 1559-1567
[Pubmed]
78 The impact of blood conservation on outcomes in cardiac surgery: Is it safe and effective?
Moskowitz, D.M., McCullough, J.N., Shander, A., Klein, J.J., Bodian, C.A., Goldweit, R.S., Ergin, M.A.
Annals of Thoracic Surgery. 2010; 90(2): 451-458
[Pubmed]
79 Risk of Adverse Outcomes Associated with Blood Transfusion After Cardiac Surgery Depends on the Amount of Transfusion
Whitson, B.A. and Huddleston, S.J. and Savik, K. and Shumway, S.J.
Journal of Surgical Research. 2010; 158(1): 20-27
[Pubmed]
80 Operative Blood Loss, Blood Transfusion, and 30-Day Mortality in Older Patients After Major Noncardiac Surgery :
Annals of Surgery. 2010; 252(1): 11
[VIEW] | [DOI]
81 Intra-operative intravenous fluid restriction reduces perioperative red blood cell transfusion in elective cardiac surgery, especially in transfusion-prone patients: a prospective, randomized controlled trial
George Vretzakis,Athina Kleitsaki,Konstantinos Stamoulis,Metaxia Bareka,Stavroula Georgopoulou,Menelaos Karanikolas,Athanasios Giannoukas
Journal of Cardiothoracic Surgery. 2010; 5(1)
[Pubmed] | [DOI]
82 The Evidence Shows That Allogeneic Transfusion Is Associated with Reduced Survival after Coronary Artery Bypass Surgery :
Irwin Gross, Aryeh Shander, Jonathan H. Waters
Anesthesiology. 2010; 112(3): 760-761
[Pubmed] | [DOI]
83 Effects of allogeneic leukocytes in blood transfusions during cardiac surgery on inflammatory mediators and postoperative complications* :
Yavuz M. Bilgin, Leo M. G. van de Watering, Michel I. M. Versteegh, Marinus H. J. van Oers, Anneke Brand
Critical Care Medicine. 2010; 38(2): 546-552
[Pubmed] | [DOI]
84 The cost and consequences of proximal femoral fractures which require further surgery following initial fixation
Thakar, C. and Alsousou, J. and Hamilton, T.W. and Willett, K.
Journal of Bone and Joint Surgery - Series B. 2010; 92 B(12): 1669-1677
[Pubmed]
85 Risk factors of blood transfusion in patients undergoing off-pump coronary artery bypass
Nia, S.K.F. and Hadadzadeh, M. and Mirhosseini, S.J. and Hosseini, H. and Abdollahi, M.H. and Yazdi, M.F. and Rasti, M. and Dehghanizadeh, H. and Ghoreishian, S.M.
Tehran University Medical Journal. 2010; 68(9): 522-526
[Pubmed]
86 Transfusion requirements after cardiac surgery: The TRACS randomized controlled trial
Hajjar, L.A. and Vincent, J.-L. and Galas, F.R.B.G. and Nakamura, R.E. and Silva, C.M.P. and Santos, M.H. and Fukushima, J. and Kalil Filho, R. and Sierra, D.B. and Lopes, N.H. and Mauad, T. and Roquim, A.C. and Sundin, M.R. and Leão, W.C. and Almeida, J.P. and Pomerantzeff, P.M. and Dallan, L.O. and Jatene, F.B. and Stolf, N.A.G. and Auler Jr., J.O.C.
JAMA - Journal of the American Medical Association. 2010; 304(14): 1559-1567
[Pubmed]
87 Variation in use of blood transfusion in coronary artery bypass graft surgery
Bennett-Guerrero, E. and Zhao, Y. and OæBrien, S.M. and Ferguson Jr., T.B. and Peterson, E.D. and Gammie, J.S. and Song, H.K.
JAMA - Journal of the American Medical Association. 2010; 304(14): 1568-1575
[Pubmed]
88 Variation in the use of recombinant activated factor VII in critical bleeding
Willis, C.D. and Cameron, P.A. and Phillips, L.
Internal Medicine Journal. 2010; 40(7): 486-493
[Pubmed]
89 Operative blood loss, blood transfusion, and 30-day mortality in older patients after major noncardiac surgery
Wu, W.-C. and Smith, T.S. and Henderson, W.G. and Eaton, C.B. and Poses, R.M. and Uttley, G. and Mor, V. and Sharma, S.C. and Vezeridis, M. and Khuri, S.F. and Friedmann, P.D.
Annals of Surgery. 2010; 252(1): 11-17
[Pubmed]
90 Minimized extracorporeal circulation in coronary artery bypass surgery is equivalent to standard extracorporeal circulation in patients with reduced left ventricular function
Puehler, T. and Haneya, A. and Philipp, A. and Camboni, D. and Hirt, S. and Zink, W. and Lehle, K. and Rupprecht, L. and Kobuch, R. and Diez, C. and Schmid, C.
Thoracic and Cardiovascular Surgeon. 2010; 58(4): 204-209
[Pubmed]
91 The perfusionistæs role in a collaborative multidisciplinary approach to blood transfusion reduction in cardiac surgery
Zelinka, E.S. and Brevig, J. and McDonald, J. and Jin, R.
Journal of Extra-Corporeal Technology. 2010; 42(1): 45-51
[Pubmed]
92 The evidence shows that allogeneic transfusion is associated with reduced survival after coronary artery bypass surgery
Gross, I. and Shander, A. and Waters, J.H.
Anesthesiology. 2010; 112(3): 760-761
[Pubmed]
93 Bloodless and non-inotropic cardiac surgery under closed-circuit anesthesia
Wu, C.-C. and Ho, S.-T. and Lin, C.-Y. and Lee, F.-Y.
Acta Anaesthesiologica Taiwanica. 2010; 48(1): 21-27
[Pubmed]
94 Intra-operative intravenous fluid restriction reduces perioperative red blood cell transfusion in elective cardiac surgery, especially in transfusion-prone patients: A prospective, randomized controlled trial
Vretzakis, G. and Kleitsaki, A. and Stamoulis, K. and Bareka, M. and Georgopoulou, S. and Karanikolas, M. and Giannoukas, A.
Journal of Cardiothoracic Surgery. 2010; 5(1)
[Pubmed]
95 Effects of allogeneic leukocytes in blood transfusions during cardiac surgery on inflammatory mediators and postoperative complications
Bilgin, Y.M. and Van De Watering, L.M.G. and Versteegh, M.I.M. and Van Oers, M.H.J. and Brand, A.
Critical Care Medicine. 2010; 38(2): 546-552
[Pubmed]
96 Effects of optimized bypass systems with retrograde autologous priming during extracorporeal circulation in high-risk patients [Auswirkungen von optimierten bypass-systemen mit retrogradem autologen priming während der extrakorporalen zirkulation bei hochrisikopatienten]
Dreizler, T. and Herbrechtsmeier, T. and Born, F. and Lipps, C. and Schmid, O. and Haimerl, G. and Botha, C.A. and Behrens, M.
Kardiotechnik. 2010; 19(1): 6-10
[Pubmed]
97 Risk of Adverse Outcomes Associated With Blood Transfusion After Cardiac Surgery Depends on the Amount of Transfusion1
Whitson, B.A. and Huddleston, S.J. and Savik, K. and Shumway, S.J.
Journal of Surgical Research. 2010; 158(1): 20-27
[Pubmed]
98 The Impact of Blood Conservation on Outcomes in Cardiac Surgery: Is It Safe and Effective?
David M. Moskowitz, Jock N. McCullough, Aryeh Shander, James J. Klein, Carol A. Bodian, Richard S. Goldweit, M. Arisan Ergin
The Annals of Thoracic Surgery. 2010; 90(2): 451
[VIEW] | [DOI]
99 Effects of optimized bypass systems with retrograde autologous priming during extracorporeal circulation in high-risk patients | [Auswirkungen von optimierten bypass-systemen mit retrogradem autologen priming während der extrakorporalen zirkulation bei hochrisikopatienten]
Dreizler, T., Herbrechtsmeier, T., Born, F., Lipps, C., Schmid, O., Haimerl, G., Botha, C.A., Behrens, M.
Kardiotechnik. 2010; 19(1): 6-10
[Pubmed]
100 Risk of Adverse Outcomes Associated With Blood Transfusion After Cardiac Surgery Depends on the Amount of Transfusion
Bryan A. Whitson,Stephen J. Huddleston,Kay Savik,Sara J. Shumway
Journal of Surgical Research. 2010; 158(1): 20
[Pubmed] | [DOI]
101 Intraoperative Transfusion of 1U to 2U Packed Red Blood Cells Is Associated with Increased 30-Day Mortality, Surgical-Site Infection, Pneumonia, and Sepsis in General Surgery Patients
D.J. Dries
Yearbook of Critical Care Medicine. 2010; 2010: 209
[Pubmed] | [DOI]
102 Bloodless and Non-inotropic Cardiac Surgery Under Closed-circuit Anesthesia
Chia-Chen Wu,Shung-Tai Ho,Chung-Yuan Lin,Fan-Yen Lee
Acta Anaesthesiologica Taiwanica. 2010; 48(1): 21
[Pubmed] | [DOI]
103 circuit on the inflammatory response during cardiopulmonary bypass
Surg, I.C.V.T.
Interactive CardioVascular and Thoracic Surgery. 2009; 8: 99
[Pubmed]
104 Intraoperative Transfusion of 1 U to 2 U Packed Red Blood Cells Is Associated with Increased 30-Day Mortality, Surgical-Site Infection, Pneumonia, and Sepsis in General Surgery Patients
Bernard, A.C. and Davenport, D.L. and Chang, P.K. and Vaughan, T.B. and Zwischenberger, J.B.
Journal of the American College of Surgeons. 2009; 208(5): 931-937
[Pubmed]
105 Advantages of Autologous Blood Transfusion in Off-Pump Coronary Artery Bypass
Yuksel Ela,Mustafa Emmiler,Cevdet Ugur Kocogullari,Yuksel Terzi,Remziye Gul Sivaci,Ahmet Cekirdekci
The Heart Surgery Forum. 2009; 12(5): E261
[Pubmed] | [DOI]
106 Factors associated with long hospital length of stay in patients receiving warfarin after cardiac surgery
Cwynar, R., Albert, N.M., Butler, R., Hall, C.
Journal of Cardiovascular Nursing. 2009; 24(6): 465-474
[Pubmed]
107 Is it the patient or the physician who cannot tolerate anemia? A prospective analysis in 1854 non-transfused coronary artery surgery patients
Senay, S., Toraman, F., Karabulut, H., Alhan, C.
Perfusion. 2009; 24(6): 373-380
[Pubmed]
108 The impact of allogenic red cell transfusion and coated bypass circuit on the inflammatory response during cardiopulmonary bypass: a randomized study
Senay, S. and Toraman, F. and Gunaydin, S. and Kilercik, M. and Karabulut, H. and Alhan, C.
Interactive CardioVascular and Thoracic Surgery. 2009; 8(1): 93-99
[Pubmed]
109 Advantages of autologous blood transfusion in off-pump coronary artery bypass
Ela, Y., Emmiler, M., Kocogullari, C.U., Terzi, Y., Sivaci, R.G., Cekirdekci, A.
Heart Surgery Forum. 2009; 12(5): E261-E265
[Pubmed]
110 eComment: Re: The impact of allogenic red cell transfusion and coated bypass circuit on the inflammatory response during cardiopulmonary bypass: a randomized study
Bockeria, L.A. and Grigoryants, R.G.
Interactive CardioVascular and Thoracic Surgery. 2009; 8(1): 99
[Pubmed]
111 Impact of Obesity on Perioperative Morbidity and Mortality after Pancreaticoduodenectomy
Williams, T.K. and Rosato, E.L. and Kennedy, E.P. and Chojnacki, K.A. and Andrel, J. and Hyslop, T. and Doria, C. and Sauter, P.K. and Bloom, J. and Yeo, C.J. and others
Journal of the American College of Surgeons. 2009; 208(2): 210-217
[Pubmed]
112 Relationships among haemoglobin level, packed red cell transfusion and clinical outcomes in patients after cardiac surgery
Oliver, E., Carrio, M.L., Rodríguez-Castro, D., Javierre, C., Farrero, E., Torrado, H., Castells, E., Ventura, J.L.
Intensive Care Medicine. 2009; 35(9): 1548-1555
[Pubmed]
113 Getting it right: Optimizing transfusion management during the procedure
McMillan, D. and Potger, K. and Southwell, J. and Ambrose, M. and Connolly, T. and Louis, M.
Journal of Extra-Corporeal Technology. 2009; 41(4): P65-P70
[Pubmed]
114 The Efficacy of an Intraoperative Cell Saver During Cardiac Surgery: A Meta-Analysis of Randomized Trials
Guyan Wang,Daniel Bainbridge,Janet Martin,Davy Cheng
Anesthesia & Analgesia. 2009; 109(2): 320
[Pubmed] | [DOI]
115 Variation in the use of recombinant activated factor VII in critical bleeding : Variation in the use of rFVIIa
C. D. Willis, P. A. Cameron, L. Phillips
Internal Medicine Journal. 2009; 40(7): 486
[VIEW] | [DOI]
116 Impact of Obesity on Perioperative Morbidity and Mortality after Pancreaticoduodenectomy
Timothy K. Williams,Ernest L. Rosato,Eugene P. Kennedy,Karen A. Chojnacki,Jocelyn Andrel,Terry Hyslop,Cataldo Doria,Patricia K. Sauter,Jordan Bloom,Charles J. Yeo,Adam C. Berger
Journal of the American College of Surgeons. 2009; 208(2): 210
[Pubmed] | [DOI]
117 Factors Associated With Long Hospital Length of Stay in Patients Receiving Warfarin After Cardiac Surgery
Roberta Cwynar,Nancy M. Albert,Robert Butler,Carol Hall
The Journal of Cardiovascular Nursing. 2009; 24(6): 465
[Pubmed] | [DOI]
118 Relationships among haemoglobin level, packed red cell transfusion and clinical outcomes in patients after cardiac surgery
Eva Oliver,Maria L. Carrio,David Rodríguez-Castro,Casimiro Javierre,Elisabet Farrero,Herminia Torrado,Eduard Castells,Josep L. Ventura
Intensive Care Medicine. 2009; 35(9): 1548
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