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Blood transfusions during CABG increased risk for pneumonia
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Patients had a greater risk for developing postoperative pneumonia if they received red blood cell transfusions during or after isolated CABG surgery, according to data presented at the Society of Thoracic Surgeons Annual Meeting.
“Pneumonia is a known risk following CABG surgery, and developing [pneumonia] has been shown to significantly increase a patient’s risk of morbidity and mortality,” Donald S. Likosky, PhD, associate professor and head of the section of health services research and quality in the department of cardiac surgery at University of Michigan Health System, said in a press release. “Previous research has shown that one in every 20 CABG patients develops a major infection, with pneumonia being the most common type of infection.”
The study included 16,182 patients who underwent CABG at any of the 33 nonfederal hospitals in Michigan where the surgeries were performed from 2011 to 2013.
According to results presented during a teleconference, 40% of patients received at least one red blood cell transfusion. About 9% of patients received one unit, 13% two units, 6% three units, 4% four units, 2% five units and 5% six or more units, Likosky said.
Of those patients who received transfusions, 3.6% — approximately four in 100 patients — developed pneumonia. Most of those patients were older, had a higher BMI, and had preexisting conditions including CVD, HF, severe lung disease and diabetes, according to Likosky.
The researchers identified a dose-dependent relationship between increasing risk for pneumonia and the amount of red blood cells administered. Among patients who received one or two red blood cell units, the risk for pneumonia was twofold compared with patients who received no transfusion. For those who received six or more red blood cell, the risk for pneumonia was 14-fold.
The findings were consistent across different clinical subgroups, including other blood products such as platelets and fresh frozen plasma, Likosky said.
“In conclusion of our statewide experience, there was a significant volume-dependent relationship between the number of red blood cells given and the development of postoperative pneumonia for patients undergoing isolated CABG. These findings were independent of differences in the patients’ presentation at the time of the operation.
“There are certainly opportunities that may be employed by clinicians to prevent the occurrence of postoperative pneumonia, including opportunities to prevent the hemodilutional effects of cardiopulmonary bypass or adopting lower transfusion thresholds among patients who are stable at the time of presentation,” Likosky concluded. – by Stephanie Viguers
For more information:
Likosky DS. Adult Cardiac Session: Ischemic. Presented at: Society of Thoracic Surgeons Annual Meeting; Jan. 24-28, 2015; San Diego.
Disclosure: Likosky reports receiving a research grant from the Agency for Healthcare Research and Quality; serving on the speakers bureau and receiving honoraria from SpecialtyCare; and serving on the advisory board/consulting for the American Society of Extracorporeal Technology.