2024/07/06 by James R. Edgerton, Giovanni Filardo, Benjamin D. Pollock +5 · 6 citations
Medicine · #Artery #Blood transfusion #Blood transfusion and management #Cardiac and Coronary Surgery Techniques #Cardiothoracic surgery #Coronary artery bypass surgery #Database #Intensive care medicine #Medicine #Perioperative #Surgery #Trauma, Hemostasis, Coagulopathy, Resuscitation
paper · pdf · doi:10.1016/j.athoracsur.2024.06.022
published in The Annals of Thoracic Surgery 118(4), 920-930 (Elsevier BV)
openalex publication_date 2024/07/06 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
BACKGROUND: Perioperative blood transfusion is associated with adverse outcomes and higher costs after coronary artery bypass graft (CABG) surgery. We developed risk assessments for patients' probability of perioperative transfusion and the expected transfusion volume to improve clinical management and resource use. METHODS: Among 1,266,545 consecutive (2008-2016) isolated CABG operations in The Society of Thoracic Surgeons Adult Cardiac Surgery Database, 657,821 (51.9%) received perioperative transfusions of red blood cells (RBC), fresh frozen plasma (FFP), cryoprecipitate, and/or platelets. We developed "full" models to predict perioperative transfusion of any blood product, and of RBC, FFP, or platelets. Using least absolute shrinkage and selection operator model selection, we built a rapid risk score based on 5 variables (age, body surface area, sex, preoperative hematocrit, and use of intra-aortic balloon pump). RESULTS: C statistics for the full model were 0.785, 0.815, 0.707, and 0.699 for any blood product, RBC, FFP, and platelets, respectively. C statistics for rapid risk assessments were 0.752, 0.785, 0.670, and 0.661 for any blood product, RBC, FFP, and platelets, respectively. The observed vs expected risk plots showed strong calibration for full models and risk assessment tools; absolute differences between observed and expected risks of transfusion were <10.8% in each percentile of expected risk. Risk assessment-predicted probabilities of transfusion were strongly and nonlinearly associated (P < .0001) with total units transfused. CONCLUSIONS: These robust and well-calibrated risk assessment tools for perioperative transfusion in CABG can inform surgeons regarding patients' risks and the number of RBC, FFP, and platelets units they can expect to need. This can aid in optimizing outcomes and increasing efficient use of blood products.