Article

Persistent effect of red cell transfusion on health-related quality of life after cardiac surgery

Department of Cardiothoracic Anesthesia, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
The Annals of thoracic surgery (Impact Factor: 3.65). 08/2006; 82(1):13-20. DOI: 10.1016/j.athoracsur.2005.07.075
Source: PubMed

ABSTRACT Although red blood cell transfusion has been associated with an increase in early morbid outcomes and reduced long-term survival after cardiac surgery, its relationship to functional quality of life after surgery has not been previously explored. Our objective was to investigate the relationship between perioperative red blood cell and component transfusion and functional health-related quality of life 6 to 12 months after cardiac surgery.
Of 12,536 patients undergoing cardiac surgical procedures between May 1995 and January 1999, 7,321 completed a self-administered Duke Activity Status Index (DASI) survey preoperatively and least one follow-up survey at nominally 6 or 12 months postoperatively. The influence of baseline DASI, preoperative risk factors, clinical status, laboratory values, operative events, and postoperative morbidities on follow-up DASI were examined with ordinal regression modeling.
After adjustment for preoperative DASI, demographic, cardiac and noncardiac comorbidity, type of surgery, postoperative complications, and interval between follow-up DASI, during which patients continued to improve (p < 0.0001), postoperative functional status after cardiac surgery was incrementally worse the more perioperative red cells (p < 0.0001) and platelets (p = 0.02) that had been transfused.
Red blood cell and platelet transfusion have an unintended persistently negative risk-adjusted effect on health-related quality of life after cardiac surgery that extends well beyond initial hospitalization. Reductions in functional recovery paralleled increasing units of red blood cells transfused.

Download full-text

Full-text

Available from: Eugene H Blackstone, Jun 30, 2015
0 Followers
 · 
77 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Allogenic blood transfusion may affect clinical outcomes negatively. Up to 20% of blood transfusions in the United States are associated with cardiac surgery and so strategies to conserve usage are of importance. This study compares administration according to physician's choice based on laboratory coagulation tests with application of a strict protocol based on the thromboelastograph (TEG). Sixty-nine patients presenting for cardiac surgery were randomised to either study or control groups. In the study group a strict protocol was followed covering usage of all blood products according to TEG patterns. In the control group, the physician directed product administration with reference to activated partial thromboplastin time (APTT), international normalised ratio (INR), fibrinogen and platelet count. Bleeding, re-sternotomy, minimum haemoglobin, intubation time, and ICU stay were documented. TEG-based management reduced total product usage by 58.8% in the study group but this was not statistically significant. This was associated with a statistically insignificant trend towards better short-term outcomes. This pilot study suggests that a strict protocol for blood product replacement based on the TEG might be highly effective in reducing usage without impairing short-term outcome.
    Heart, Lung and Circulation 08/2009; 18(4):277-88. DOI:10.1016/j.hlc.2008.08.016 · 1.17 Impact Factor
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: To begin, we must agree on what we mean by a learning system and a learning control system. A system is called learning if the information pertaining to the unknown features of a process or its environment is acquired by the system, and the obtained experience is used for future estimation, recognition, classification, decision or control such that the performance of the system will be improved. A learning system is called a learning control system if the acquired information is used to control a process with unknown features (these standardized definitions are taken from Reference 1). The attribute of "learning" that is associated with learning systems, derives from psychological learning theories, especially reinforcement learning theories.
    Decision and Control including the 13th Symposium on Adaptive Processes, 1974 IEEE Conference on; 01/1974