Abstract

Abstract 2277

Background:

Transfusion of blood products remains an essential intervention during hospitalization for cardiac surgeries. Published data reveal significant variability in the patterns of transfusion of blood products among different centers. In addition, published data suggest that allogenic transfusions are associated with worse outcomes in cardiac surgery patients.

This project was conducted to investigate for significant variability in transfusion practices in the management of cardiac surgery patients in the 4 cardiac surgery centers within the province of British Columbia (BC). Secondary objectives include assessing for correlation of specific patient and surgical characteristics with risk of transfusion, in addition to comparing one-year mortality in patients who received transfusions with those who did not.

Methods:

A retrospective review of data collected through the BC Cardiac Registry (BCCR) was performed. All adult patients who underwent cardiac surgery in BC between January 1,2008 to December 31,2010 were included. The following patients were excluded: Jehovah's witnesses, heart transplantation recipients and patients who underwent aortic aneurysm repair not including aortic valve surgery. In patients who underwent more that one surgery within 365 days, data were only collected for the first cardiac surgery.

The following data were collected: age, gender, type of surgery, clinical urgency, institution, preoperative hemoglobin, preoperative eGFR, duration of cardio-pulmonary bypass and use of cell saver technology. Mortality data over 1 year post operatively and quantities of packed red blood cells (PRBCs), frozen plasma (FP), platelets and cryoprecipitate (cryo) transfused during surgery and within 30 days afterwards were also collected. Cardiac surgery centers were anonymized.

Chi-square test and Fisher exact test were used to analyze variation in transfusion requirements. Kaplan-Meir curves will be created for estimation of survival. Multivariate regression analysis will be used to identify risk factors for transfusion.

Results:

After excluding patients as outlined above, 8352 patients were included in the analysis.

A summary of transfusion rates of different blood products in different types of cardiac surgeries among different centers is summarized in table 1.

Statistical analysis is currently in progress to assess for association between transfusion of blood products and survival, in addition to multivariate analysis to identify risk factors for transfusion.

Conclusions:

Significant differences are noted in transfusion requirement of PRBCs, FP and platelets during and within 30 days of cardiac surgery among the four different cardiac surgery centers in British Columbia. The differences are not accounted for by surgery type alone. Further research is required to identify factors to account for the observed variability. Consideration will be made for development of further measures for standardization of transfusion management in this patient group.

Table 1:

Rates of transfusion of different blood products classified by type of surgery and surgical center. Letters A-D represent anonymized surgical centers. CHD: Congenital heart disease

Surgery type, number of patients (%)Blood productsPatients who received transfusions by surgical center %p-Value
ABCDBC
CABG, N= 5326 (63.8) PRBCs 61.4 38.29 27.23 41.97 42.79 <0.0001 
FP 11.05 2.75 21.18 20.14 13.93 <0.0001 
Platelets 16.57 2.18 9.63 19.65 12.41 <0.0001 
Cryo 0.28 0.89 0.48 0.21 0.45 0.0459 
Pure valve, N=1376 (16.5) PRBCs 57.72 36.2 31.83 33.53 38.88 <0.0001 
FP 11.74 8.9 28.98 27.49 20.13 <0.0001 
Platelets 10.74 3.68 14.01 27.79 14.17 <0.0001 
Cryo 1.34 1.53 0.24 1.21 1.02 0.1963 
CABG+valve, N=1121 (13.4) PRBCs 79.21 62.41 53.98 51.33 61.82 <0.0001 
FP 18.28 8.28 39.1 35.74 25.16 <0.0001 
Platelets 17.92 4.83 24.22 39.54 21.23 <0.0001 
Cryo 2.87 0.34 1.38 1.9 1.61 0.0919 
CABG+valve+other, N=137 (1.6) PRBCs 95.24 62.3 54.55 45.45 62.77 0.0041 
FP 19.05 11.48 39.39 27.27 21.9 0.0160 
Platelets 19.05 6.56 18.18 45.45 17.52 0.0008503 
Cryo 4.76 1.64 1.46 0.4434 
Valve+other, N=230 (2.8) PRBCs 67.65 38.67 42.19 31.58 42.17 0.0072 
FP 17.65 5.33 50 47.37 30 <0.0001 
Platelets 20.59 1.33 31.25 40.35 22.17 <0.0001 
Cryo 3-13 1.75 1.3 0.3441 
CHD repair N=162 (1.9) PRBCs 50 38.89 28.57 33.33 35.19 0.2327 
FP 13.33 16.67 30.16 39.22 28.4 0.0551 
Platelets 3.33 5.56 11.11 27.45 14.2 0.0107 
Cryo 5.56 3.92 1.85 0.1448 
Surgery type, number of patients (%)Blood productsPatients who received transfusions by surgical center %p-Value
ABCDBC
CABG, N= 5326 (63.8) PRBCs 61.4 38.29 27.23 41.97 42.79 <0.0001 
FP 11.05 2.75 21.18 20.14 13.93 <0.0001 
Platelets 16.57 2.18 9.63 19.65 12.41 <0.0001 
Cryo 0.28 0.89 0.48 0.21 0.45 0.0459 
Pure valve, N=1376 (16.5) PRBCs 57.72 36.2 31.83 33.53 38.88 <0.0001 
FP 11.74 8.9 28.98 27.49 20.13 <0.0001 
Platelets 10.74 3.68 14.01 27.79 14.17 <0.0001 
Cryo 1.34 1.53 0.24 1.21 1.02 0.1963 
CABG+valve, N=1121 (13.4) PRBCs 79.21 62.41 53.98 51.33 61.82 <0.0001 
FP 18.28 8.28 39.1 35.74 25.16 <0.0001 
Platelets 17.92 4.83 24.22 39.54 21.23 <0.0001 
Cryo 2.87 0.34 1.38 1.9 1.61 0.0919 
CABG+valve+other, N=137 (1.6) PRBCs 95.24 62.3 54.55 45.45 62.77 0.0041 
FP 19.05 11.48 39.39 27.27 21.9 0.0160 
Platelets 19.05 6.56 18.18 45.45 17.52 0.0008503 
Cryo 4.76 1.64 1.46 0.4434 
Valve+other, N=230 (2.8) PRBCs 67.65 38.67 42.19 31.58 42.17 0.0072 
FP 17.65 5.33 50 47.37 30 <0.0001 
Platelets 20.59 1.33 31.25 40.35 22.17 <0.0001 
Cryo 3-13 1.75 1.3 0.3441 
CHD repair N=162 (1.9) PRBCs 50 38.89 28.57 33.33 35.19 0.2327 
FP 13.33 16.67 30.16 39.22 28.4 0.0551 
Platelets 3.33 5.56 11.11 27.45 14.2 0.0107 
Cryo 5.56 3.92 1.85 0.1448 
Disclosures:

No relevant conflicts of interest to declare.

Author notes

*

Asterisk with author names denotes non-ASH members.