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A risk assessment study of co-morbidities associated with the transfusion of packed red blood cells during elective coronary artery bypass grafting / Tiffany K. Lindquist.

by Lindquist, Tiffany K.

Cardiopulmonary bypass -- Adverse effects

Heart -- Surgery -- Physiological aspects.

Blood Preservation.

Blood -- Transfusion

Coronary artery bypass

105 leaves : ill. ; 29 cm.

Thesis advisor(s): Dr. Ronald Gerrits.

Committee members: Dr. Larry Fennigkoh, Matthew Hietpas.

Introduction -- Background -- Hypothesis -- Methods -- Results -- Discussion -- Limits of study -- Conclusion -- References -- A: Patient dynamics -- B: Physiologic correlation data -- C. Mantel Haenszel Chi-Square (X2) of postoperative complications -- D. Variables of stepwise binary logistic regression -- E. Institutional review board consent documents.

Ischemic heart disease has tripled in the last two decades, and in conjunction with the increased incidence of disease, is a concomitant rise in the use of antithrombotic and fibrinolytic drugs used during heart surgery. These drugs, although necessary, increase the potential for bleeding among the patients who need them, and may lead to treatment by blood transfusions. Among the numerous decisions that must be made during the management of the cardiac surgery patient, the decision of when to transfuse is among the most controversial. In theory, transfusing blood increases oxygen delivery and improves outcomes, but there is no definitive evidence to support such a practice. In fact, although transfusions of packed red blood cells (RBCs) have been shown to increase with patient factors such as age, gender, and disease states, such transfusions have been independently linked in some studies to a more negative patient outcome after a variety of surgeries. A few of the adverse effects include increased infection, prolonged mechanical ventilation and mortality rates.

In order to try to determine when RBCs should be given, a retrospective study was performed on patients admitted to Aurora Center Hospitals in the Milwaukee area who underwent elective coronary artery bypass grafting (CABG). Patients were grouped by the amount of units of leukocyte-reduced packed red blood cells (pRBCs) they had received during the intraoperative and postoperative periods. This study was carried out to determine which combinations of preoperative demographics and risk factors were the best predictors of pRBC usage during elective CABG. In addition, a multivariate logistic model was used to statistically compare the dose-reponse relationship in infection, prolonged mechanical ventilation and mortality to the amount of pRBC units transfused.

Results of this research will be used to predict patient transfusion needs and compare the benefits to the risks in deciding when it is best to transfuse pRBCs using a risk score analysis. The model will then be able to predict pRBC usage and its risks for more complex surgeries, such as redo, valve and aneurysm operations.

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