Increased mortality, morbidity, and cost associated with red blood cell transfusion after cardiac surgery.

PURPOSE OF REVIEW

Literature since 2006 was reviewed to identify the harms and costs of red blood cell (RBC) transfusion.

RECENT FINDINGS

Several studies, on people having various cardiac surgery operations, found strong associations of RBC transfusion with mortality and postoperative morbidity. The effect on mortality was strongest close to the time of operation but extended to 5 years. Morbidity outcomes included serious wound and systemic infections, renal failure, prolonged ventilation, low cardiac index, myocardial infarction, and stroke. RBC transfusion was also strongly associated with increased intensive care and ward postoperative stay, and hence increased cost of admission; available studies did not consider all resources used and the associated costs.

SUMMARY

The harms of RBC transfusion have potentially serious and long-term consequences for patients and are costly for health services. This evidence should shift clinicians' equipoise towards more restrictive transfusion practice. The immediate aim should be to avoid transfusing small numbers of RBC units for general malaise attributed to anaemia, a practice which appears to occur in about 50% of transfused patients. Randomized trials comparing restrictive and liberal transfusion triggers are urgently needed to compare directly the balance of benefits and harms from RBC transfusion.