{"id":3883,"date":"2010-10-13T09:38:03","date_gmt":"2010-10-13T13:38:03","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=3883"},"modified":"2011-07-19T17:44:46","modified_gmt":"2011-07-19T21:44:46","slug":"transfusions-and-cardiac-surgery-a-major-concern","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2010\/10\/13\/transfusions-and-cardiac-surgery-a-major-concern\/","title":{"rendered":"Transfusions and Cardiac Surgery: “A Major Concern”"},"content":{"rendered":"

One new study in JAMA<\/em> demonstrates very wide differences among hospitals in the use of transfusions during cardiac surgery. A second study finds no differences in outcome based on transfusions. Two editorialists write that “continued inappropriate transfusions among hospitals is a major concern.”<\/p>\n

Bennett-Guerro and colleagues<\/a> analyzed the Society of Thoracic Surgeons Adult Cardiac Surgery Database\u00a0to assess the rate of perioperative blood transfusions in over 100,000 patients who underwent CABG in 2008. The transfusion rate across CABG sites ranged from 7.8% to 92.8% for red blood cells (RBCs) and from 0% to 97.5% for fresh-frozen plasma. Although geographic location, academic status, and hospital volume were all significant factors, these three characteristics accounted for only a small (11.1%) portion of the variation in risk-adjusted RBC usage. The investigators write that\u00a0“to our knowledge, there has never been a large randomized trial of the safety and efficacy of blood transfusion in cardiac surgery; therefore, some of the variability we observed may be due to honest differences between clinicians in the perceived benefits and risks of transfusion.”<\/p>\n

In an attempt to shed some light on the topic, Hajjar and colleagues<\/a> performed the propspective Transfusion Requirements After Cardiac Surgery (TRACS) clinical trial. They randomized 502 patients at a single university hospital in Brazil to either a liberal strategy of blood transfusion or a restrictive strategy (hematocrit goal of ><\/span> 30% or ><\/span>24%). Some 78% of patients in the liberal strategy group received a transfusion, compared with 47% in the restrictive-strategy group. The composite endpoint of 30-day mortality, cardiogenic shock, acute respiratory distress syndrome, or acute injury requiring dialysis or hemofiltration did not differ significantly between the two groups (10% vs. 11%, P=0.85).<\/p>\n

In an accompanying editorial<\/a>, Aryeh Shander and Lawrence Goodnough observe that Society of Thoracic Surgeons ratings of cardiac surgery programs do not include RBC transfusions as a quality indicator and suggest that “it may be time for patient blood management to gain status as a performance indicator by accreditation agencies such as the Joint Commission or as a quality indicator by professional organizations.” They conclude:<\/p>\n

“When evaluating a hemoglobin level, treating physicians must resist the temptation to ‘first do something’ and temper this temptation with a philosophy of ‘first do no harm’ to achieve the optimal balance of providing the best risk-benefit and cost-effective outcomes of transfusion therapy for patients.”<\/p>\n","protected":false},"excerpt":{"rendered":"

One new study in JAMA demonstrates very wide differences among hospitals in the use of transfusions during cardiac surgery. A second study finds no differences in outcome based on transfusions. Two editorialists write that “continued inappropriate transfusions among hospitals is a major concern.” Bennett-Guerro and colleagues analyzed the Society of Thoracic Surgeons Adult Cardiac Surgery […]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20],"tags":[231,232,475],"class_list":["post-3883","post","type-post","status-publish","format-standard","hentry","category-cardiac-surgery","tag-cabg","tag-surgery","tag-transfusions"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/3883","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=3883"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/3883\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=3883"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=3883"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=3883"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}