Background: Anemia in cardiac surgery patients has been associated with poor outcomes. Transfusion of red\nblood cells during surgery is common practice for perioperative anemia, but may come with risks. Little is known\nabout the association between intra-operative transfusion and mortality in patients undergoing cardiac surgery.\nMethods: Single centre historical cohort study in 2933 adult patients undergoing coronary surgery with or without\naortic valve replacement from June 2011 until September 2014. To estimate the odds ratio for mortality in patients\nreceiving intra-operative transfusion, a propensity score based logistic regression analysis was performed.\nResults: Intra-operative transfusion was associated with a more than three-fold increased risk of 30-day mortality.\nPatients in the highest quartile of probability of transfusion were older (age 75 vs 66; P < 0.001), had a higher\nEuroSCORE (6 vs 3; P < 0.001), had lower preoperative hemoglobin levels (7.6 vs 8.9 mmol/l; P < 0.001), had\ncombined surgery more often (CABG + AVR in 33.4% of cases vs 6.6% (P < 0.001) and a longer duration of surgery\n(224 vs 188 min; P < 0.001). The association between intra-operative transfusion and mortality persisted after\nadjustment for these risk factors (adjusted OR 2.6; P = 0.007).\nConclusions: Intra-operative transfusion of red blood cells was found to be associated with increased mortality in\nadults undergoing coronary surgery. Preoperative patient optimization may improve perioperative outcomes by\nreducing the likelihood of requiring transfusion and thus its associated risk.
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