Vol.3 - No.1

Blood Transfusion After Pediatric Cardiac Surgery Is Associated with Prolonged Hospital Stay

By : baghaei

Keywords : -

Background: Red blood cell transfusion is associated with
morbidity and mortality among adults undergoing cardiac
surgery. We aimed to evaluate the association of transfusion with morbidity among pediatric cardiac surgical patients.
Methods: Patients discharged after cardiac surgery in 2003
were retrospectively reviewed. The red blood cell volume
administered during the first 48 postoperative hours was
used to classify patients into nonexposure, low exposure (
15 mL/kg), or high exposure (>15 mL/kg) groups. Cox
proportional hazards modeling was used to evaluate the as-
sociation of red blood cell exposure to length of hospital
stay (LOS).

Results

Results: Of 802 discharges, 371 patients (46.2%) required
blood transfusion. Demographic differences between the
transfusion exposure groups included age, weight, prematu-
rity, and noncardiac structural abnormalities (all p < 0.001).
Distribution of Risk Adjusted Classification for Congeni-
tal Heart Surgery, version 1 (RACHS-1) categories, intra-
operative support times, and postoperative Pediatric Risk
of Mortality Score, Version III (PRISM-III) scores varied
among the exposure groups (p < 0.001). Median duration
of mechanical ventilation (34 hours [0 to 493] versus 27
hours [0 to 621] versus 16 hours [0 to 375]), incidence of
infection (21 [14%] versus 29 [13%] versus 17 [4%]), and
acute kidney injury (25 [17%] versus 29 [13%] versus 34
[8%]) were highest in the high transfusion exposure group
when compared with the low or nontransfusion groups (all
p < 0.001). In a multivariable Cox proportional hazards
model, both the low transfusion group (adjusted hazard ra-
tio [HR] 0.80, 95% confidence interval [CI]: 0.66 to 0.97, p
= 0.02) and high transfusion group (adjusted HR 0.66, 95%
CI: 0.53 to 0.82, p < 0.001) were associated with increased
LOS. In subgroup analyses, both low transfusion (adjusted
HR 0.81, 95% CI: 0.65 to 1.00, p = 0.05) and high transfu-
sion (adjusted HR 0.65, 95% CI: 0.49 to 0.87, p = 0.004) in
the biventricular group but not in the single ventricle group
was associated with increased LOS.

Conclusion

Conclusions: Blood transfusion is associated with prolonged
hospitalization of children after cardiac surgery, with biven-
tricular patients at highest risk for increased LOS. Future
studies are necessary to explore this association and refine
transfusion practices

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