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Category: Volume 06 Issue 12 December 2018
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Title: Allogenic Blood Transfusion and Post-operative Outcomes in Elective CABG cases: A Prospective Study

Authors: Jain Pramesh, Gupta Animesh, Dr Ansuman Mondal

 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.35

Abstract

Aims and Objectives: To assess the relationship between RBC/whole blood transfusion and hospital length of stay in a large, single reference centre of cardiac surgery and then to compare the characteristics of patients who received RBC/whole blood transfusion with those who did not.

Material and Methods: The study will be conducted in the Dept of CTVS of SSKM Hospital, Kolkata-WB. Patients admitted for OP CABG intervention in CTVS department from April 2014 to July 2015. Sample size was 60 cardiac patients. Of the 60 patients included in analysis patients receiving blood transfusion are selected for study group. The control group consists of patients will not require blood transfusion.

Results: From the total of 126 patients randomized chose in this study.33 did not receive any RBC transfusion (26.19%) labelled them Group 1; 55 (43.65%) patients were given 1–3 units labelled them Group 2 and 38 (30.15%) received more than 3 RBC units labelled them Group 3 in the first 72 postoperative hours. From 126 patients, 91 (72.22%) patients received transfusion at the operative room and day 0(day of surgery), 58 (46.03%) received at the first postoperative day (1PO), 19(15.08%) at the second postoperative day (2PO) and 5 (3.97%) at the third postoperative day (3PO). Analysing postoperative clinical complications, We found that patients from the high transfusion group presented a higher incidence of postoperative complications related to the composite endpoint 30-day all-cause mortality (p <0.017) and acute respiratory distress syndrome, and higher Re-intubation rates (p <0.004). Regarding infections in patients from group2 and group3 as compared with group1 we found that both groups were associated with significant p values {(both deep and sternal infections) and (p <0.005 &<0.020 respectively)} It indicate blood transfusion is independent morbid factor in OPCABG patients.

In our study, we compared ventilator weaning off time of the patients in different groups; we found that patients with blood transfused groups require much more time as compared to non- transfused group in all sub groups. In group1 27(81.82%) patients were extubated in 12-18 hrs postoperatively, and remaining 6 (18.18%) patients in 18-24hrs postoperatively. In group2 41 (74.55%) patients extubated in 12-18hrs, 11(20%) patient’s extubated in 18- 24hrs, and only one pt took long time for weaning off from ventilator postoperatively. While in group3 only 11 (28.95%) patients wean-off in 12-18 hrs, 19 (50%) patients require 18-24 hrs time for extubation, and remaining 7 patients were extubated between 24-48 hrs postoperatively. 3 patients could not be taken off from ventilator. Higher mortality rates were directly related to blood transfusions. In our study total no. mortality was 10. Out of these 7 deaths occur in high transfusion group i.e. group3, 2 deaths occurred in group2 and one mortality had occurred in nontransfusedgroup. Main objective our study was to found association between blood transfusion and length of stay (LOS-no. of days from day of surgery till discharge/death). In our study, Length of stay had range between 6-12 days in group1; 6-28 days in group2, and 9-45 days in group3 with mean & standard deviation of 7.71 +/- 1.67 days in group1, 9.49 +/- 4.33 days in group2 and 16.18 +/- 7.64days in group3 respectively. When we were comparing p values of group1, 2 &3 we found highly significant values among the groups. Compare the group1 & 2 p value was 0.029; between group1 &3 and Group2 &3 it was highly significant (0.0001). These calculations showed that no. of blood transfusions are directly responsible for increase in the length of hospitalisation of patient.

Conclusion: In conclusion, our data for OPCABG shows that patients who received transfusion required significantly longer ventilator support time, longer inotropic support time, increase rates of re-intubation. All these factors combine to increase morbidity and delays patient’s recovery process. In our study, we found that blood transfusions increase the rates of superficial and deep sternal wound infections, increases hospital stay of patient. All above factors contributing to increase mortality in higher blood transfused patients. They also had significantly higher incidence of the 30-day mortality. Thus we suggest that for better patient outcome, early recovery, full utilisation of scarce resources, decrease unnecessary economic burden to community, we should approach toward the restricted blood transfusions and pre-op management of risk factors. 

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Corresponding Author

Jain Pramesh

Postgraduate Resident, Department of CTVS, I.P.G.M.E & R.SSKM Hospital, Kolkata- WB