Year : 2008  |  Volume : 11  |  Issue : 2  |  Page : 135--136

Is blood transfusion an independent predictor of increased resource utilisation and postoperative morbidity?


Mukul C Kapoor 
 Department of Anaesthesiology, Army Hospital (Research and Referral), Delhi, India

Correspondence Address:
Mukul C Kapoor
Senior Adviser Cardiothoracic Anaesthesiology, Army Hospital R and R, Delhi - 110 010
India




How to cite this article:
Kapoor MC. Is blood transfusion an independent predictor of increased resource utilisation and postoperative morbidity?.Ann Card Anaesth 2008;11:135-136


How to cite this URL:
Kapoor MC. Is blood transfusion an independent predictor of increased resource utilisation and postoperative morbidity?. Ann Card Anaesth [serial online] 2008 [cited 2020 Sep 24 ];11:135-136
Available from: http://www.annals.in/text.asp?2008/11/2/135/41589


Full Text

The Editor,

Blood product transfusion after cardiopulmonary bypass (CPB) is a common event in cardiac surgery. CPB alters haemostasis, which predisposes the patient to perioperative transfusion and may result in increased morbidity and mortality. Changes due to CPB include haemodilution, consumption of platelets / coagulation factors, platelet dysfunction and activation of the coagulation / fibrinolytic cascades. The factors associated with the requirement of blood transfusion include time on CPB, temperature on CPB, patient gender, type of surgery, combined procedures, repeat procedures, older age and preoperative aspirin use. [1],[2],[3],[4]

Scott et al. , in their article titled 'Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery' have concluded that blood transfusion is an independent predictor of increased resource utilisation and postoperative morbidity. [5] The two groups studied are statistically dissimilar in terms of preoperative morbidity, operative techniques, intraoperative management protocols, transfusion triggers and postoperative morbidity. The authors have further not differentiated data presented for patients in terms of off-pump and on-pump coronary artery bypass graft surgery. The transfused group had more co-morbidity and was sicker than the nontransfused group and the transfusion protocols required them to reach a target haematocrit of 30%. The transfused group showed significantly higher use of the mammary graft and an exceptionally high (73.1%) use of intra-aortic balloon pump. The above conditions, apart from many other factors brought out in the article, contributed to increased resource utilisation and postoperative mortality apart from the need to transfuse blood.

The data presented confirms others' observation that a number of perioperative factors are predictors of blood usage [1],[2],[3],[4] and that the requirement of blood transfusion is associated with increased resource utilisation and postoperative morbidity. However, the need for blood transfusion depends on these associated factors and thus, cannot be an independent predictor of increased resource utilisation and postoperative morbidity. Statistically, blood transfusion is definitely associated with increased resource utilization and postoperative morbidity but calling it an independent predictor is definitely questionable.

References

1Despotis GJ, Kriton SF, Zoys TN, et al . Factors associated with postoperative blood loss and hemostatic transfusion requirements: A multivariate analysis in cardiac surgical patients. Anesth Analg 1996;82:13-21.
2Shore-Lesserson L, Reich DL, Silvay G, Griepp RB. Hemostasis in aortic and cardiothoracic surgery. J Cardiovasc Surg 1997;12:232-7.
3Parr 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.
4Utley 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.
5Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilization, morbidity and mortality in cardiac surgery. Ann Card Anaesth 2008;11:15-9.