Efforts to Change Transfusion Practice and Reduce Transfusion Rates Are Effective in Coronary Artery Bypass Surgery

Objectives: Efforts to decrease allogeneic blood transfusion and avoid unnecessary transfusions in cardiac surgery are important because transfusions are associated with increased postoperative morbidity and mortality. The purpose of the present study was to evaluate the long-term effects of multidisciplinary efforts to reduce allogeneic blood transfusion rates and avoid unnecessary red blood cell (RBC) transfusions in primary elective coronary artery bypass graft (CABG) surgery.

Design: A retrospective observational study.

Setting: A single center study in a university-affiliated hospital.

Participants: A total of 450 patients undergoing primary elective CABG surgery during 2004, 2008, or 2010.

Interventions: The application of systematic multimodal perioperative blood-sparing techniques and interventions directed to change transfusion behaviors.

Measurements And Main Results: The results from an audit on transfusion practices in 2004 were compared with similar audits performed in 2008 and 2010 using a before-and-after study design. The patient populations were comparable throughout the years. The median postoperative chest tube bleeding was decreased from 950 mL in 2004 to 750 mL in 2010. The proportion of patients transfused with allogeneic blood products was decreased from 64% to 47%. Overtransfusion with allogeneic RBCs defined as the proportion of patients transfused with RBCs discharged with hemoglobin >7 mmol/L (11.3 g/dL) was reduced from 36% to 16%.

Conclusions: Multimodal efforts to change transfusion behaviors and decrease transfusion rates in CABG surgery have persistent effects for several years.