Background/Case Studies: Cardiac surgery stands out with a notably higher blood transfusion (BT) requirement compared to other surgical procedures. Research highlights that heart surgeries contribute to 10% to 15% of all red blood cell (RBC) transfusions. Patients afflicted with coronary heart diseases exhibit varying degrees of coronary artery stenosis, leading to prolonged myocardial hypoxia. During surgical interventions or emergencies, perioperative anemia exacerbates tissue hypoxia, potentially impacting patient prognosis. Common post-surgical issues include shock, abnormal blood function, pulmonary causes, and neurological events. Renal failure is observed in approximately 30% of patients, and overall mortality rates range from 1% to 5%. The use of cardiopulmonary bypass during heart surgery often triggers abnormal blood coagulation, significant blood loss, and complications or infection events following BT. These events have been associated with 30-day mortality rates, ischemic incidents, infections, renal insufficiency, and complications. Consequently, perioperative BT presents a complex challenge for healthcare professionals. Determining the precise amount of transfusion required before surgery becomes crucial in meeting patients’ needs and optimizing outcomes.
This study aims to investigate the BT volume and postoperative complications in cardiac surgery by analyzing the data in National Health Insurance Research Database for further applying the implementation status of Patient Blood Management (PBM).
Study
Design/Methods: 2059 patients identified as receiving coronary artery bypass grafting (CABG) or/and aortic valve replacement/repair (AVR) during the 2000–2012 period. Patients with BT were further divided in groups of ≤4 units, 5-10 and >10 units of blood. The Cox proportional hazards regression analysis was conducted to estimate the effects of the BT in cardiac surgeries. The chi-square test and Analysis of variance (ANOVA) was used to examine for the differences between the variables in BT and non-BT groups.
Results/Findings: 85.72% of the patients received BT. The usages of coagulopathy, or anti-platelet agents, autogenous blood storage, or cell salvage are significantly associated with BT. Peripheral vascular disease, ischemic stroke and patients with autogenous blood storage had statistically increased risk of massive RBC transfusion. Conversely, cell salvage was more associated with the lowest tier of transfusions.The patients received more than 10 units of RBC had a higher risk of renal failure. The patient with BT had a longer hospital stay and intensive care unit (ICU) stay and consumed higher medical cost. Conclusions: Our national study indicated BT significantly associated the postoperative complications; the length of hospital stays (LHS) and medical cost of BT in cardiac surgeries. Furthermore, our findings indicate that clinicians should be aware of PBM is of the essence in cardiac surgeries.
