Risk factors associated with the use of red blood cells in elective cardiac surgeries: A patient blood management (PBM) view

Abstract

Background  Blood is a biological, irreplaceable, and perishable resource, provided through voluntary, altruistic, and free donation in Brazil. Although blood components are widely used in hospital settings, several challenges persist, including the limited availability of these resources, the high costs associated with their procurement, storage, and transfusion, as well as the risks inherent in the allogeneic transfusion process due to potential transfusion reactions. Therefore, there is a need to focus on Patient Blood Management (PBM) within the Brazilian transfusion system to reduce the need for transfusions, particularly of packed red blood cells, during elective cardiac surgeries.

Objective  To evaluate the risk factors associated with the use of packed red blood cells in elective cardiac surgeries performed at the Hospital das Clínicas, Faculty of Medicine, Botucatu.

Methods  This retrospective study involving 741 individuals was conducted between 2018 and 2021 with the approval of an ethics research committee. Data were analyzed using descriptive statistics, the Chi-square test, and stepwise logistic regression, with the level of significance set at 5 %.

Results and conclusion  Preoperative factors such as female sex (Odds ratio: 9.074; p-value <0.0001), low hematocrit levels (Odds ratio: 7.498; p-value = 0.0034), and the presence of diabetes mellitus (Odds ratio: 1.779; p-value = 0.0318), as well as intraoperative factors such as extracorporeal circulation time greater than 90 min (Odds ratio: 1.68; p-value = 0.0442), were identified as risk factors for excessive bleeding and the need for packed red blood cells during surgery.

Keywords
Blood transfusion; Patient blood management; Cardiac surgery; Intraoperative bleeding; Diabetes mellitus