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Autologous blood donation during surgery reduces morbidity, mortality risk
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An intraoperative autologous donation protocol used in patients during cardiac surgery was safe and effective in minimizing perioperative morbidity and mortality, according to data presented at The Society for Thoracic Surgeons Annual Meeting.
“Aggressive [intraoperative autologous donation] is an effective blood conservation strategy that leads to improved outcomes in cardiac surgery,” Eric Zimmermann, MD, resident at NewYork-Presbyterian Queens, and colleagues wrote.
Researchers analyzed data from 688 patients who underwent surgery between 2009 and 2017. Data included outcomes of patients before (n = 268; mean age, 66 years; 65% men) and after (n = 420; mean age, 64 years; 74% men) an aggressive intraoperative autologous donation protocol was implemented in the department in January 2013.
Variables included in this study were chest tube output, length of stay, packed red blood cell transfusions, type of procedure, demographics and outcomes.
Patients who underwent surgery after the protocol was implemented required fewer blood transfusions after surgery compared with those who underwent surgery before the protocol was implemented (70% vs. 40%; P < .001). In addition, these patients had shorter lengths of stay (7.8 days vs. 6.8 days; P < .001), fewer total transfusions (1.76 packed red blood cells vs. 0.79 packed red blood cells; P < .001) and lower chest tube output (1,295 mL vs. 1,207 mL; P = .038).
“We 100% agree that this is not definitive, but hope it promotes additional interest in the subject,” Zimmermann told Cardiology Today. “We hope it will motivate prospective studies to bring more scientific rigor to the subject.”
He noted that for publication, his team will perform multivariate logistic regression to determine if the effect remains after adjustment. – by Darlene Dobkowski
Reference:
Zimmerman E, et al. The Multidisciplinary Team: How We Do It. Presented at: The Society for Thoracic Surgeons Annual Meeting; Jan. 27-29, 2019; San Diego.
Disclosure: Zimmermann reports receiving research grant funding from the NIH.
Perspective
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Mario F.L. Gaudino, MD
Autologous blood donation is not a new idea. It has been around forever that if you are able to donate autologous blood and avoid red blood cell transfusions, the outcomes are better.
There are probably two mechanisms. One is a true biological effect because transfusions are associated with adverse reactions, potential infections and immunosuppression. Avoiding a transfusion is extremely important and it will definitely translate into clinical benefit.
There is also a selection bias, especially in studies like this. The selection bias means that we are in some way selecting the patient that get autologous blood donation in the sense that they are somewhat different from the patient who does not. Autologous blood donation requires a little bit more work, time and the donation per se because you take out some volume that can be tolerated only by a healthy individual or at least an individual in good shape. Those patients who are candidates for autologous blood donation cannot be too sick or too urgent. This is a major confounder that needs to be taken into account when analyzing this kind of study.
It is very likely that there is a biological effect, but confounding by indication or a selection bias may also explain those results.
Much more research is needed. This is a preliminary study. The authors must be commended for this presentation, but their analysis is not adjusted for major confounders. They are comparing two patient populations in different time periods. There is also an evolution of technique and of management. This is an excellent start point, but it cannot be seen as a definitive conclusion. Our research efforts should focus on blood management and, in general, the attempt to make this operation safer.
I do not see any downside to this technique if a patient can tolerate it. It is definitely something that is useful.
Twenty years ago, CABG was a risky operation. There was a sizable amount of operative risk. At that time, the main goal of the surgeon was just to have a patient who is alive after surgery. Now, the operative risk is below 1%. Having a patient who is alive must not be taken for granted now, but we also need to maximize the benefit of the operation and minimize the downside of the operation as much as we can.
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