Predictors of transfusion of packed red blood cells in coronary artery bypass grafting surgery

Objectives: Finding predictors of blood transfusion may facilitate the most efficient approach for the use of blood bank services in coronary artery bypass grafting procedures. The aim of this retrospective study is to identify preoperative and intraoperative patient characteristics predicting the need for blood transfusion during or after CABG in our local cardiac surgical service. Methods: 435 patients undergoing isolated first-time CABG were reviewed for their preoperative and intraoperative variables and analyzed postoperative data. Patients were 255 males and 180 females, with mean age 62.01 +/- 10.13 years. Regression logistic analysis was used for identifying the strongest perioperative predictors of blood transfusion. Results: Blood transfusion was used in 263 patients (60.5%). The mean number of transfused blood products units per patient was 2.27 +/- 3.07 (0-23) units. The total number of transfused units of blood products was 983. Univariate analysis identified age >65 years, weight <70 Kg, body mass index <25 Kg/m2, hemoglobin <= 13mg/dL, hematocrit <= 40% and ejection fraction <50%, use of cardiopulmonary bypass (CPB), not using an internal thoracic artery as a bypass, and multiple bypasses as significant predictors. The strongest predictors using multivariate analysis were hematocrit <= 40% (OR 2.58; CI 1.62-4.15; P<0.001), CPB use (OR 2.00; CI 1.27-3.17; P=0.003) and multiple bypasses (OR 2.31; CI 1.31-4.08; P=0.036). Conclusions: The identification of these risk factors leads to better identification of patients with a grater probability of using blood, allocation blood bank resources and cost-effectiveness use of blood products.