Association of complications with blood transfusions in pediatric cardiac surgery patients.
BACKGROUND
Blood product transfusion during cardiopulmonary bypass has been demonstrated to be associated with increased morbidity and mortality in adult cardiac surgery populations. The aim of this study was to characterize the risk-adjusted occurrence of postoperative complications and mortality in relation to intraoperative blood product transfusion in our pediatric cardiac surgery population.


METHODS
A retrospective review was performed on 1,631 consecutive cardiopulmonary bypass cases to determine the effects of intraoperative blood product transfusion on selected outcomes. After adjusting for patient and operative risk factors, multivariate analysis was performed to determine the association between blood product transfusion and postoperative complications. Cox proportional hazards model was used to examine the relationship of packed red blood cell transfusion to hospital length of stay.


RESULTS
Red blood cell and fresh frozen plasma transfusion was associated with pulmonary complications (adjusted odds ratio, 1.55; 95% confidence interval, 1.05 to 2.28; p=0.03). Red blood cell transfusion also correlated with prolonged hospital stay (p<0.01). Cryoprecipate transfusion was associated with postoperative pulmonary complications (adjusted odds ratio, 1.79; 95% confidence interval, 1.13 to 2.55; p=0.01), but decreased incidence of 30-day mortality (adjusted odds ratio, 0.44; 95% confidence interval, 0.23 to 0.85; p=0.02). Platelet transfusion was associated with decreased 30-day mortality (adjusted odds ratio, 0.51; 95% confidence interval, 0.28 to 0.93; p=0.04), but not overall mortality.


CONCLUSIONS
Blood product transfusion was associated with an increased incidence of postoperative pulmonary complications and prolonged hospital length of stay, but not overall mortality. These findings suggest that minimizing blood product transfusion would be beneficial in the pediatric cardiopulmonary bypass surgery patient population.
['Iyengar|Amit|A|', 'Scipione|Christopher N|CN|', 'Sheth|Parth|P|', 'Ohye|Richard G|RG|', 'Riegger|Lori|L|', 'Bove|Edward L|EL|', 'Devaney|Eric J|EJ|', 'Hirsch-Romano|Jennifer C|JC|']
D000293:Adolescent D006348:Cardiac Surgical Procedures D002315:Cardiopulmonary Bypass D002423:Cause of Death D002648:Child D002675:Child, Preschool D015331:Cohort Studies D016001:Confidence Intervals D017707:Erythrocyte Transfusion D005260:Female D005500:Follow-Up Studies D017052:Hospital Mortality D006801:Humans D015994:Incidence D007223:Infant D007430:Intraoperative Care D008297:Male D015999:Multivariate Analysis D016017:Odds Ratio D011183:Postoperative Complications D016016:Proportional Hazards Models D012189:Retrospective Studies D018570:Risk Assessment D016896:Treatment Outcome
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