Transfusion Policies for Cardiac Surgery Vary in U.S.

Outcomes of transfusion at hematocrit of 30 percent not better than at hematocrit of 24 percent
By Lindsey Marcellin
HealthDay Reporter

TUESDAY, Oct. 12 (HealthDay News) -- Transfusion practices vary widely among institutions providing cardiac surgery, but a restrictive perioperative transfusion status does not appear to be inferior to a more liberal transfusion strategy in terms of 30-day morbidity and mortality, according to two studies published in the Oct. 13 issue of The Journal of the American Medical Association.

Ludhmila A. Hajjar, M.D., Ph.D., of the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo in Brazil, and colleagues conducted a prospective, randomized, controlled clinical noninferiority trial of a restrictive blood transfusion policy (to maintain a hematocrit of 24 percent or greater) compared with a liberal transfusion policy (to maintain a hematocrit of 30 percent or greater). The researchers found no significant difference in 30-day all-cause mortality and severe morbidity between the two groups; however, the number of transfused red blood cell units was an independent risk factor for an adverse outcome at 30 days.

Elliott Bennett-Guerrero, M.D., of Duke University Medical Center in Durham, N.C., and colleagues conducted a study of blood and blood-product transfusion practices for coronary artery bypass graft surgeries and the differences in these transfusion practices among U.S. hospitals. Transfusion practices varied based on three hospital characteristics -- geographic location, academic status, and hospital volume -- but these combined factors accounted for only a very small percentage of the variation in hospital risk-adjusted red blood cell usage. Hospital transfusion rates were not significantly associated with all-cause mortality.

"The influence of attending surgeons' attitudes has been documented," write the authors of an accompanying editorial. "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."

An author of the second study is a named inventor on a patent application related to methods of washing red blood cells.

Abstract - Hajjar
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Abstract - Bennett-Guerrero
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Editorial (subscription or payment may be required)

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