Efficacy and Feasibility of Preoperative Autologous Blood Donation in Elective On-pump Cardiac Surgeries: A Propensity-score Matching Study
DOI:
https://doi.org/10.59958/hsf.8119Keywords:
preoperative autologous blood donation, cardiopulmonary bypass, allogenic transfusion, propensity score matchingAbstract
Objective: The global shortage of blood resources has become a significant concern. This study aimed to assess the effects and feasibility of preoperative autologous blood donation (PABD) in elective on-pump cardiac surgeries. Methods: This retrospective single-center study included 219 patients who underwent elective on-pump cardiac surgeries between January 2015 and June 2023. All procedures were performed by a single experienced surgical team. Of these patients, 101 (PABD group) donated autologous blood preoperatively and were compared with the Non-PABD group (n = 118). Using the propensity-score matching (PSM) method, 83 well-matched pairs were yielded based on five variables: gender, age, baseline hemogloin level, left ventricular ejection fraction (LVEF), and EuroscoreII. Transfusion data and perioperative outcomes were retrospectively compared. Multivariate logistic regression analyses were employed to assess the independent impact of PABD on outcome indicators. Results: In the propensity-matched cohort, there were significant reductions in allogenic red blood cell (RBC) transfusion in the PABD group, both intraoperatively and postoperatively (p < 0.05). Patients in the PABD group experienced a shorter duration of mechanical ventilation (p < 0.05). There was no significant difference in early mortality (p = 0.613). However, the incidences of hemoglobinuria and acute kidney injury (AKI) were significantly lower in the PABD group (p = 0.016 and p = 0.043, respectively). Furthermore, the use of PABD was identified as an independent protective factor for postoperative AKI odds ratio (OR = 0.204; 95% CI, 0.051–0.816; p = 0.025) and hemoglobinuria (OR = 0.141; 95% CI, 0.027–0.723; p = 0.019). Conclusion: The use of PABD in cardiac surgeries is beneficial, reducing allogenic RBC transfusions and certain complications without increasing adverse events.
References
Zimmermann E, Zhu R, Ogami T, Lamonica A, Petrie JA, 3rd, Mack C, et al. Intraoperative Autologous Blood Donation Leads to Fewer Transfusions in Cardiac Surgery. The Annals of Thoracic Surgery. 2019; 108: 1738–1744. https://doi.org/10.1016/j.athoracsur.2019.06.091.
Norton EL, Kim KM, Fukuhara S, Monaghan KP, Naeem A, Wu X, et al. Autologous blood transfusion in acute type A aortic dissection decreased blood product consumption and improved postoperative outcomes. JTCVS Open. 2022; 12: 20–29. https://doi.org/10.1016/j.xjon.2022.07.005.
Zeroual N, Blin C, Saour M, David H, Aouinti S, Picot MC, et al. Restrictive Transfusion Strategy after Cardiac Surgery. Anesthesiology. 2021; 134: 370–380. https://doi.org/10.1097/ALN.0000000000003682.
Zheng J, Chen L, Qian L, Jiang J, Chen Y, Xie J, et al. Blood conservation strategies in cardiac valve replacement: A retrospective analysis of 1645 patients. Medicine. 2016; 95: e5160. https://doi.org/10.1097/MD.0000000000005160.
Wu J, Chen G, Wang L, Wang P, Han Y, Yang L, et al. Investigation on the feasibility of large-volume autologous red blood cells donation: A pilot trial in a small cohort of Chinese. Journal of Clinical Apheresis. 2023; 38: 447–456. https://doi.org/10.1002/jca.22048.
Kracalik I, Mowla S, Basavaraju SV, Sapiano MRP. Transfusion-related adverse reactions: Data from the National Healthcare Safety Network Hemovigilance Module - United States, 2013-2018. Transfusion. 2021; 61: 1424–1434. https://doi.org/10.1111/trf.16362.
Xu X, Zhang Y, Gan J, Ye X, Yu X, Huang Y. Association between perioperative allogeneic red blood cell transfusion and infection after clean-contaminated surgery: a retrospective cohort study. British Journal of Anaesthesia. 2021; 127: 405–414. https://doi.org/10.1016/j.bja.2021.05.031.
Ćatić D, Milojković A, Steblovnik L. Preoperative autologous blood donation in placenta previa patients. Transfusion and Apheresis Science: Official Journal of the World Apheresis Association: Official Journal of the European Society for Haemapheresis. 2018; 57: 793–796. https://doi.org/10.1016/j.transci.2018.11.003.
Lim MH, Je HG, Ju MH, Lee JH, Oh HR, Kim YR. Effects of Preoperative Autologous Blood Donation in Patients Undergoing Minimally Invasive Cardiac Surgery. The Korean Journal of Thoracic and Cardiovascular Surgery. 2019; 52: 385–391. https://doi.org/10.5090/kjtcs.2019.52.6.385.
Martin K, Keller E, Gertler R, Tassani P, Wiesner G. Efficiency and safety of preoperative autologous blood donation in cardiac surgery: a matched-pair analysis in 432 patients. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 2010; 37: 1396–1401. https://doi.org/10.1016/j.ejcts.2009.11.053.
Jiang F, He J, Wu H, Wu L, Sun N, Li M, et al. Development and Validation of a Nomogram to Predict the Risk of Blood Transfusion in Orthognathic Patients. The Journal of Craniofacial Surgery. 2022; 33: 2067–2071. https://doi.org/10.1097/SCS.0000000000008568.
Takami Y, Masumoto H. Predictors of allogenic blood transfusion in elective cardiac surgery after preoperative autologous blood donation. Surgery Today. 2009; 39: 306–309. https://doi.org/10.1007/s00595-008-3893-5.
Nashef SAM, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al. EuroSCORE II. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 2012; 41: 734–744; discussion 744–745. https://doi.org/10.1093/ejcts/ezs043.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Critical Care (London, England). 2004; 8: R204–R212. https://doi.org/10.1186/cc2872.
Zhang Z, Kim HJ, Lonjon G, Zhu Y, written on behalf of AME Big-Data Clinical Trial Collaborative Group. Balance diagnostics after propensity score matching. Annals of Translational Medicine. 2019; 7: 16. https://doi.org/10.21037/atm.2018.12.10.
Dietrich W, Thuermel K, Heyde S, Busley R, Berger K. Autologous blood donation in cardiac surgery: reduction of allogeneic blood transfusion and cost-effectiveness. Journal of Cardiothoracic and Vascular Anesthesia. 2005; 19: 589–596. https://doi.org/10.1053/j.jvca.2005.04.017.
Paone G, Likosky DS, Brewer R, Theurer PF, Bell GF, Cogan CM, et al. Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality. The Annals of Thoracic Surgery. 2014; 97: 87–93; discussion 93–94. https://doi.org/10.1016/j.athoracsur.2013.07.020.
Henderson RA, Mazzeffi MA, Strauss ER, Williams B, Wipfli C, Dawood M, et al. Impact of intraoperative high-volume autologous blood collection on allogeneic transfusion during and after cardiac surgery: a propensity score matched analysis. Transfusion. 2019; 59: 2023–2029. https://doi.org/10.1111/trf.15253.
Kindzelski BA, Corcoran P, Siegenthaler MP, Horvath KA. Postoperative acute kidney injury following intraoperative blood product transfusions during cardiac surgery. Perfusion. 2018; 33: 62–70. https://doi.org/10.1177/0267659117712405.
Rasmussen SR, Kandler K, Nielsen RV, Jakobsen PC, Ranucci M, Ravn HB. Association between transfusion of blood products and acute kidney injury following cardiac surgery. Acta Anaesthesiologica Scandinavica. 2020; 64: 1397–1404. https://doi.org/10.1111/aas.13664.
Karkouti K. Transfusion and risk of acute kidney injury in cardiac surgery. British Journal of Anaesthesia. 2012; 109 Suppl 1: i29–i38. https://doi.org/10.1093/bja/aes422.
Bennett-Guerrero E, Veldman TH, Doctor A, Telen MJ, Ortel TL, Reid TS, et al. Evolution of adverse changes in stored RBCs. Proceedings of the National Academy of Sciences of the United States of America. 2007; 104: 17063–17068. https://doi.org/10.1073/pnas.0708160104.
Cislaghi F, Condemi AM, Corona A. Predictors of prolonged mechanical ventilation in a cohort of 5123 cardiac surgical patients. European Journal of Anaesthesiology. 2009; 26: 396–403. https://doi.org/10.1097/EJA.0b013e3283232c69.
Fritsch SJ, Dreher M, Simon TP, Marx G, Bickenbach J. Haemoglobin value and red blood cell transfusions in prolonged weaning from mechanical ventilation: a retrospective observational study. BMJ Open Respiratory Research. 2022; 9: e001228. https://doi.org/10.1136/bmjresp-2022-001228.
Karkouti K, McCluskey S. Pro: Preoperative autologous blood donation has a role in cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2003; 17: 121–125. https://doi.org/10.1053/jcan.2003.23.
Priye S, Sathyanarayan J, Shivaprakash S, Reddy D. Perioperative management of patient with Bombay blood group undergoing mitral valve replacement. Indian Journal of Anaesthesia. 2015; 59: 811–813. https://doi.org/10.4103/0019-5049.171577.
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