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Perioperative trajectory of haemoglobin, predictors of blood transfusion and tailoring targets for patient blood management interventions: A single-centre, retrospective study of non-emergent cardiac surgery patients

Mihai Ștefan
Mihai Ștefan
, 
Anca Roxana Lupu
Anca Roxana Lupu
, 
Ștefan Andrei
Ștefan Andrei
, 
Liana Văleanu
Liana Văleanu
, 
Ovidiu Știru
Ovidiu Știru
, 
Cornel Robu
Cornel Robu
, 
Teodora Bute
Teodora Bute
, 
Bianca Moroșanu
Bianca Moroșanu
, 
Anamaria Dumitrescu
Anamaria Dumitrescu
, 
Alice Stegaru
Alice Stegaru
, 
Șerban Bubenek
Șerban Bubenek
 et 
Daniela Filipescu
Daniela Filipescu
   | 29 déc. 2022
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Article Category: Original Paper
Publié en ligne: 29 déc. 2022
Pages: 47 - 56
DOI: https://doi.org/10.2478/rjaic-2021-0008
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© 2021 Mihai Ștefan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Study flowchart. CPB, cardiopulmonary bypass
Study flowchart. CPB, cardiopulmonary bypass

Figure 2

Perioperative trajectory of Hb in the whole cohort, anaemic and non-anaemic patients. Values on chart represent g/dl haemoglobin at four time points – 1 at hos pital admission, 2 immediately before surgery, 3 immediately after surgery and 4 at hospital discharge. Numbers on the figure refer to Hb levels expressed as g/dl. Hb, haemoglobin
Perioperative trajectory of Hb in the whole cohort, anaemic and non-anaemic patients. Values on chart represent g/dl haemoglobin at four time points – 1 at hos pital admission, 2 immediately before surgery, 3 immediately after surgery and 4 at hospital discharge. Numbers on the figure refer to Hb levels expressed as g/dl. Hb, haemoglobin

Figure 3

Transfusion of PRBCs in non-anaemic versus anaemic patients during the perioperative period.
Transfusion of PRBCs in non-anaemic versus anaemic patients during the perioperative period.

Types of surgeries.

Type of surgery Number of patients
CABG 259 (36.48%)
One valve 251 (35.35%)
Two or more valves 67 (9.44%)
Valve(s) and CABG 60 (8.45%)
Surgery on aorta 46 (6.48%)
Other 27 (3.8%)

Demographic characteristics and outcomes of the whole cohort, anaemic and non-anaemic patients.

Variables Whole cohort (n = 710) Hb <13 g/dl (n = 288, 40.5%) Hb ≥13 g/dl (n = 422, 59.4%) P-value
Age 64 (58–69) 66 (59–71) 63 (57–68) <0.001
Male sex, n (%) 469 (66%) 148 (51.4%) 321 (76.0%) <0.001
Chronic kidney disease (eGFR <60 ml/min) 58 (8.1%) 29 (10%) 29 (6.8%) 0.058
Hb at hospital admission 13.3 (12.3–14.4) 12 (11.2–12.6) 14.3 (13.5–14.9) <0.001
Hb preoperative 13.3 (12.2–14.4) 12 (11.2–12.5) 14.2 (13.5–14.8) <0.001
Hb postoperative 9.9 (8.9–10.8) 9.3 (8.5–10.1) 10.4 (9.4–11.3) <0.001
Hb at discharge 9.7 (9–10.6) 9.4 (8.8–10) 10.1 (9.2–10.8) <0.001
Duration of surgery (min) 270 (220–333) 275 (220–347) 270 (220–330) 0.798
Hospital LOS (days) 13 (10–17) 14 (10–17) 13 (10–16) 0.826
ICU LOS (days) 2 (2–4) 2 (2–4) 2 (2–4) 0.181
Postoperative bleeding- 24 h (ml) 375 (275–550) 375 (275–550) 375 (275–550) 0.325
Surgical re-exploration, n (%) 45 (6.3%) 23 (8%) 22 (5.2%) 0.136
Hospital death, n (%) 23 (3.2%) 13 (4.5%) 10 (2.4%) 0.113
PRBC transfusion, n (%) 369 (52%) 206 (71.5%) 163 (38.6%) <0.001
Total PRBC transfusion, (n) 1 (0–2) 2 (0–3) 0 (0–1) <0.001
Preoperative PRBC transfusion 0 0 0
Intraoperative transfusion 0 (0–1) 1 (0–2) 0 (0–1) <0.001
Postoperative transfusion 0 (0–1) 0 (0–1) 0 (0–0) <0.001
ROTEM use, n (%) 123 (17.3%) 58 (20.1%) 65 (15.4%) 0.102
Cell saver, n (%) 7 (1%) 4 (1.4%) 3 (0.7%) 0.450
Patients receiving FFP transfusion, n (%) 184 (25.9%) 93 (32.3%) 91 (21.6%) 0.001
FFP units per patient, n 0 (0–2) 0 (0–2) 0 (0–0) 0.001
Patients receiving PLT transfusion, n (%) 66 (9.3%) 31 (10.8%) 35 (8.3%) 0.266

Univariate and multivariate analyses of the association between perioperative variables and transfusion risk.

Variables Univariate
 Multivariate
OR (95% CI) p OR (95% CI) p
Age 1.038 (1.023–1.053) <0.001 1.024 (1.0008–1.049) 0.043
Female sex 3.249 (2.331–4.528) <0.001 3.224 (1.648–6.306) 0.014
Hospital LOS 1.039 (1.014–1.064) 0.002 1.093 (1.037–1.151) <0.001
ICU LOS 1.068 (1.013–1.127) 0.015 1.029 (0.93–1.138) 0.579
CKD (eGFR <60 ml/min) 2.104 (1.013–1.127) 0.011 1.051 (0.365–3.027)
Surgery time (h) 1.127 (1.012–1.256) 0.003 0.949 (0.827–1.088) 0.440
Hospital death 10.228 (2.38–43.959) 0.002 Not included in the model
Preoperative Hb <13 g/dl 3.992 (2.892–5.510) <0.001 3.462 (1.766–6.787) <0.001
Hb1 0.559 (0.496–0.630) <0.001 Not included in the model
Hb2 0.594 (0.530–0.685) <0.001 Not included in the model
Hb3 0.567 (0.500–0.642) <0.001 0.564 (0.434–0.732) <0.001
Hb4 0.785 (0.691–0.891) <0.001 Not included in the model
Postop bleeding ≥500 ml 2.592 (1.754–3.833) <0.001 2.295 (1.044–5.045) 0.039
Surgical re-exploration 3.469 (1.690–7.119)) 0.001 1.132 (0.195–6.580) 0.687
ROTEM use 4.090 (2.590–6.457) <0.001 1.568 (0.723–3.401) 0.255
FFP use 7.083 (4.639–10.816) <0.001 5.110 (1.997–13.071) <0.001
PLT use 0.169 (0.085–0.335) <0.001 1.690 (0.360–7.928) 0.276
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