Impact of Preoperative Hematocrit, Body Mass Index, and Red Cell Mass on Allogeneic Blood Product Usage in Adult Cardiac Surgical Patients: Report From a Statewide Quality Initiative

Authors

Kenichi A. Tanaka, Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Electronic address: kenichi-tanaka@ouhsc.edu.
Diane Alejo, Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Mehrdad Ghoreishi, Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Rawn Salenger, Department of Cardiothoracic Surgery, St. Joseph Medical Center, University of Maryland, Towson, MD.
Clifford Fonner, Maryland Cardiac Surgery Quality Initiative, Baltimore, MD.
Niv Ad, Department of Cardiothoracic Surgery, Adventist Healthcare, Silver Spring, MD.
Glenn Whitman, Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Bradley S. Taylor, Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Michael A. Mazzeffi, George Washington University School of Medicine and Health Sciences, Washington, D.C.

Document Type

Journal Article

Publication Date

2-1-2023

Journal

Journal of cardiothoracic and vascular anesthesia

Volume

37

Issue

2

DOI

10.1053/j.jvca.2022.03.034

Keywords

blood transfusion; body mass index; cardiopulmonary bypass; obesity; postoperative complications

Abstract

OBJECTIVE: The study aims were to evaluate current blood transfusion practice in cardiac surgical patients and to explore associations between preoperative anemia, body mass index (BMI), red blood cell (RBC) mass, and allogeneic transfusion. DESIGN: Multicenter retrospective study. SETTING: Academic and non-academic centers. PARTICIPANTS AND INTERVENTIONS: After Institutional Review Board approval, 26,499 patients who underwent coronary artery bypass grafting ± valve replacement/repair between 2011 and 2019 were included from the Maryland Cardiac Surgery Quality Initiative database. Patients were stratified into BMI categories (<25, 25 to <30, and ≥30 kg/m), and a multivariable logistic regression model was fit to determine if preoperative hematocrit, BMI, and RBC mass were associated independently with allogeneic transfusion. RESULTS: Preoperative anemia was found in 55.4%, and any transfusion was administered to 49.3% of the entire cohort. Females and older patients had lower BMI and RBC mass. Increased RBC and cryoprecipitate transfusions occurred more frequently after surgery in the lower BMI group. After adjustments, increased transfusion was associated with a BMI <25 relative to a BMI ≥30 at an odds ratio (OR) of 1.26 (95% confidence interval [CI]: 1.08-1.39). For each 1% increase in preoperative hematocrit, transfusion was decreased by 9% (OR: 0.91; 95% CI: 0.90-0.92). For every 500 mL increase in RBC mass, there was a 43% reduction of transfusion (OR: 0.57; 95% CI: 0.55-0.58). CONCLUSIONS: Transfusion probability modeling based on calculated RBC mass eliminated sex differences in transfusion risk based on preoperative hematocrit, and may better delineate which patients may benefit from more rigorous perioperative blood conservation strategy.

APA Citation

Tanaka, Kenichi A.; Alejo, Diane; Ghoreishi, Mehrdad; Salenger, Rawn; Fonner, Clifford; Ad, Niv; Whitman, Glenn; Taylor, Bradley S.; and Mazzeffi, Michael A., "Impact of Preoperative Hematocrit, Body Mass Index, and Red Cell Mass on Allogeneic Blood Product Usage in Adult Cardiac Surgical Patients: Report From a Statewide Quality Initiative" (2023). GW Authored Works. Paper 2500.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2500

Department

Anesthesiology and Critical Care Medicine