Red Blood Cell Transfusion and Pulmonary Complications: STS Adult Cardiac Surgery Database Analysis

BACKGROUND:Intraoperative packed red blood cell (PRBC) transfusion during cardiac surgery is associated with increased postoperative morbidity and mortality; however, data regarding association between PRBC transfusion and postoperative pulmonary complications (PPCs) is somewhat conflicting. Using the Society of Thoracic Surgeons' Adult Cardiac Surgery Database, we sought to determine whether intraoperative PRBC transfusion was associated with PPCs as well as longer intensive care unit (ICU) stay after isolated coronary artery bypass grafting (CABG) surgery. METHODS:A registry-based cohort study was performed on 751,893 patients with isolated CABG between January 1, 2015, to December 31, 2019. Using propensity-score-weighted regression analysis, we analyzed the effect of intraoperative PRBC on the incidence of PPCs (hospital acquired pneumonia [HAP], mechanical ventilation >24 hours or reintubation), ICU length of stay, and ICU readmission. RESULTS:Transfusion of 1, 2, 3 and ³4 units of PRBCs was associated with increased odds for HAP [odds ratios (ORs) 1.24 (1.21-1.26), 1.28 (1.26-1.32), 1.36 (1.33-1.39), 1.31 (1.28-1.34)], reintubation [ORs 1.23 (1.21-1.25), 1.38 (1.35-1.40), 1.57 (1.55-1.60), 1.70 (1.67-1.73], prolonged ventilation [ORs 1.34 (1.33-1.36), 1.56 (1.53-1.58), 1.97 (1.94-2.00), 2.27 (2.24-2.30)], initial ICU length of stay [mean difference in hours, 6.79 (6.00-7.58), 9.55 (8.71-10.38), 17.26 (16.38-18.15), 22.14 (21.22-23.06)], readmission to ICU [ORs 1.14 (1.12-1.64), 1.15 (1.12-1.17), 1.15 (1.13-1.18), 1.32 (1.29-1.35], and additional ICU length of stay [mean difference in hours, 0.55 (0.18-0.92), 0.38 (0.00-0.77), 1.02 (0.61-1.43), 1.83 (1.40-2.26)]. CONCLUSIONS:Intraoperative PRBC transfusion was associated with increased incidence of PPCs, prolonged ICU stay, and ICU readmissions after isolated CABG surgery.