Intraoperative Packed Red Blood Cell Transfusion and Pulmonary Complications

Intraoperative packed red blood cell transfusion may increase pulmonary complications and ICU readmissions after isolated coronary artery bypass graft surgery, suggests a new study published in the Annals of Thoracic Surgery.

Intraoperative packed red blood cell (PRBC) transfusion during cardiac surgery is associated with increased postoperative morbidity and mortality; however, data regarding the association between packed red blood cell transfusion and postoperative pulmonary complications (PPCs) is somewhat conflicting. Using the Society of Thoracic Surgeons Adult Cardiac Surgery Database, we sought to determine whether intraoperative packed red blood cell transfusion was associated with postoperative pulmonary complications as well as longer intensive care unit (ICU) stays after isolated coronary artery bypass grafting (CABG) surgery.

A registry-based cohort study was performed on 751,893 patients with isolated coronary artery bypass grafting between January 1, 2015, to December 31, 2019. Using propensity-score–weighted regression analysis, they analyzed the effect of intraoperative packed red blood cells on the incidence of postoperative pulmonary complications (hospital-acquired pneumonia [HAP], mechanical ventilation >24 hours or reintubation), ICU length of stay, and ICU readmission.

Results

Transfusion of 1, 2, 3 and ≥4 units of packed red blood cells was associated with increased odds for hospital-acquired pneumonia, reintubation, prolonged ventilation, initial ICU length of stay, and readmission to ICU. Intraoperative packed red blood cell transfusion was associated with increased incidence of postoperative pulmonary complications, prolonged ICU stay, and ICU readmissions after isolated coronary artery bypass grafting surgery.

Reference

Jacob Raphael, Alice Chae, Xiaoke Feng, Matthew S. Shotwell, Michael A. Mazzeffi, Bruce A. Bollen, Douglas Pfeil, Eric Feduska, Ashish S. Shah, Miklos D. Kertai,
Red Blood Cell Transfusion and Pulmonary Complications: STS Adult Cardiac Surgery Database Analysis. The Annals of Thoracic Surgery, 2024, ISSN 0003-4975. https://doi.org/10.1016/j.athoracsur.2023.12.012.
https://www.sciencedirect.com/science/article/pii/S0003497524000055

Keywords

• Intraoperative PRBC transfusion
• Pulmonary complications
• CABG
• ICU readmissions
• CABG surgery
• The Annals of Thoracic Surgery
• Society of Thoracic Surgeons’ Adult Cardiac Surgery Database
• Red blood cell transfusion
• Coronary artery bypass grafting surgery
• Hospital acquired pneumonia
• Length of stay
• Jacob Raphael
• Alice Chae
• Xiaoke Feng
• Matthew S. Shotwell
• Michael A. Mazzeffi
• Bruce A. Bollen
• Douglas Pfeil
• Eric Feduska
• Ashish S. Shah
• Miklos D. Kertai