S. Naeem1, G. Baird2, N. Sodha1, F. Sellke1, A. Ehsan1 1The Warren Alpert Medical School,Cardio-Thoracic Surgery,Providence, RHODE ISLAND, USA 2Rhode Island Hospital,Lifespan Bio-Statistics,Providence, RHODE ISLAND, USA
Introduction:
Packed red blood cell (PRBC) and platelet transfusion are associated with morbidity and mortality among adults undergoing cardiac surgery. Our objective was to investigate the clinical effect of transfusion among acute type A aortic dissection (AAD) patients undergoing surgical repair in a large referral hospital.
Methods:
The medical records of 93 AAD patients were retrospectively reviewed and stratified into cohorts by median PRBC and platelet units received; PRBC ≤2 units (N=62) vs PRBC >2 units (N=31); platelets ≤1 unit (N=66) vs platelets >1 unit (N=27). The same dataset was also categorized into four groups; Group 0=no transfusion (N=8); Group 1=platelets only (N=10); Group 2= PRBC and platelets (N=66); Group 3= PRBC only (N=9). Multivariate logistic regression was applied to drive p-values for post-transfusion complications after adjusting for age, gender, history of hypertension and diabetes. Kaplan Meier survival analyses were used to compare the hospital length of stay (LOS) and survival rate at 1-month and 1-year.
Results:
Baseline demographics were similar between all groups. Patients receiving >2U of PRBC had median LOS of 15 vs 8 days, p<0.001. Transfusion of >2 units of PRBC was identified to be an independent risk factor for postoperative infection (OR=5.9, 95% CI: 1.6-21.7, p=0.006). One-month survival rate was 90% in patients receiving ≤2 units PRBC vs 90% in patients receiving >2 units, p=0.811. At 1 year, the survival rate was 89% in patients receiving ≤2 units of PRBC vs 80% in patients receiving >2 units, p=0.644. Patients receiving >1 unit of platelets had a median LOS of 15 vs 10 days, p<0.05. Transfusion of >1 unit of platelets was identified as an independent risk factor for postoperative atrial fibrillation and acute renal failure (OR=2.9, 95% CI: 1.1-8.0, p=0.026; OR=3.7, 95% CI: 1.3-10.6, p=0.014, respectively). One-month survival rate was 89% in patients receiving ≤1 unit of platelets vs 92% in patients receiving >1 unit, p=0.510. At 1 year, the survival rate was 88% in patients receiving ≤1 unit of platelets vs 81% in patients receiving >1 units, p=0.947. On pairwise analysis for the four groups using life table, there was a statistically significant difference in median LOS between group 0 vs 1 (6 vs 8 days, p=0.019) and group 0 vs 2 (6 vs 13 days, p=0.005). Survival at 1-month was 88% for group 0, 100% for group 1, 91% for group 2 and 78% for group 3, (p=0.425). Additionally, survival rate at 1-year was 88% for group 0, 100% for group 1, 84% for group 2 and 78% for group 3, (p=0.507). These results are not statistically significant likely due to the small number of patients.
Conclusion:
Transfusion of PRBC and platelets above a particular threshold increases the incidence of postoperative complications and hospital LOS among patients undergoing repair of AAD.