Issue |
J Extra Corpor Technol
Volume 51, Number 4, December 2019
|
|
---|---|---|
Page(s) | 195 - 200 | |
DOI | https://doi.org/10.1051/ject/201951195 | |
Published online | 15 December 2019 |
Original Articles
Net Prime Volume Is Associated with Increased Odds of Blood Transfusion
* Mayo Clinic, Rochester, Minnesota
† Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
‡ Westchester Medical Center, Valhalla, New York
§ Medical University of South Carolina, Charleston, South Carolina; and
¶ Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Michigan
Address correspondence to: Donald S. Likosky, PhD, Section Head, Section of Health Services Research and Quality, Department of Cardiac Surgery, Michigan Medicine, 5346 Frankel Cardiovascular Center, 1500 E. Med Center Drive, Ann Arbor, MI 48109. E-mail: likosky@med.umich.edu
Received:
21
August
2018
Accepted:
13
September
2019
Hemodilutional anemia has been cited as a contributing factor to red blood cell (RBC) transfusions in cardiac surgery patients. Accordingly, efforts have been made to minimize hemodilution by reducing cardiopulmonary bypass (CPB) prime volume. We sought to assess the impact of these efforts on intraoperative RBC transfusions. We evaluated 21,360 patients undergoing coronary artery bypass with or without aortic valve surgery between July 2011 through December 2016 at any of 42 centers participating in the Perfusion Measures and Outcomes registry. The primary exposure was net CPB prime volume (total prime volume minus retrograde autologous prime volume) indexed to body surface area (mL/m2), which was further divided into quartiles (Q1: <262 mL/m2, Q2: 262–377 mL/m2, Q3: 377–516 mL/m2, and Q4: >516 mL/m2). The primary outcome was intraoperative RBC transfusion. We modeled the effect of index net prime volume on transfusion, adjusting for patient (age, gender, race, diabetes, vascular disease, previous myocardial infarction, ejection fraction, creatinine, preoperative hematocrit (HCT), total albumin, status, aspirin, and antiplatelet agents), procedural (procedure types) characteristics, surgical year, and hospital. The median net prime volume was 378 mL/m2 (25th percentile: 262 mL/m2, 75th percentile: 516 mL/m2). Relative to patients in Q1, patients in Q4 were more likely to be older, female, nondiabetic, have higher ejection fraction, have more ultrafiltration volume removed, and undergo more elective and aortic valve procedures (all p < .05). Patients in Q4 relative to Q1 were exposed to lower nadir HCTs on bypass, p < .05. The net prime volume was associated with an increased risk of transfusion (8.9% in Q1 vs. 22.6% in Q4, p < .001). After adjustment, patients in Q4 (relative to Q1) had a 2.9-fold increased odds (ORadj = 2.9, 95% CI [2.4, 3.4]) of intraoperative RBC transfusion. In this large, multicenter experience, patients exposed to larger net prime volumes were associated with greater adjusted odds of receiving intraoperative transfusions. Our findings reinforce the importance of efforts to reduce the net CPB prime volume. Based on these findings and other supporting evidence, the net prime volume should be adopted as a national quality measure.
Key words: cardiopulmonary bypass (CPB) / blood transfusion / CPB circuit prime volume
Dr. Paone now practices at Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA 30322.
Dr. Likosky is supported in part by grant number R01HS026003 from the Agency for Healthcare Research and Quality (AHRQ). The opinions expressed in this document are those of the authors and do not reflect the official position of the AHRQ or the U.S. Department of Health and Human Services. Support for the MSTCVS Quality Collaborative is provided by the Blue Cross and Blue Shield of Michigan (BCBSM) and Blue Care Network as part of the BCBSM Value Partnerships program. Although BCBSM and MSTCSV-QC work collaboratively, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of BCBSM or any of its employees.
© 2019 AMSECT
Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.
Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.
Initial download of the metrics may take a while.