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Abstract
Purpose
There is currently no consensus on the most appropriate blood transfusion strategy for older adults undergoing cardiovascular surgery. We aimed to investigate the potential benefits of the patient blood management (PBM) program specifically for advanced age patients, and to evaluate the relationship of age and PBM in cardiovascular surgery.
Patients and Methods
We collected data from patients over 60 years old who underwent on-pump cardiovascular surgery. We compared transfusion and clinical outcomes between the pre-PBM and post-PBM groups using a propensity score matching method. Then, we conducted a subgroup analysis within the original cohort, specifically focusing on patients aged of 75 and above with multivariable adjusted models.
Results
Data of 9703 older adults were analyzed. Red blood cell (RBC) transfusion rates during cardiopulmonary bypass (CPB) (31.6% vs 13.1%, P<0.001), during the operation (50.8% vs 39.0%, P<0.001) and after the operation (5.6% vs 3.1%, P<0.001) were significantly reduced, and mortality and the risk of some adverse events were also reduced after the PBM. Subgroup analysis showed that there was no interaction between age and PBM, and advanced age (over age 75) did not modify the effect of PBM program in reducing RBC transfusion (Pinteraction=0.245), on mortality (Pinteration=0.829) and on certain complications.
Conclusion
The comprehensive PBM program could reduce RBC transfusion without adverse outcomes in older patients undergoing CPB. Even patients over age 75 may benefit from a more stringent transfusion indication. Comprehensive blood conservation measures should be applied to optimize the blood management for older patients.
Abbreviations
AKI, Acute kidney injury; BMI, Body mass index; CABG, Coronary artery bypass grafting; CPB, Cardiopulmonary bypass; ECMO, Extracorporeal membrane oxygenation; EF, Ejection fraction; IABP, Intra-aortic balloon pump; ICU, Intensive care unit; LVAD, Left ventricular assist device; MECC, Mini-extracorporeal circulation system; PBM, Patient blood management; PSM, Propensity score matching; RBC, Red blood cell; SMD, Standardized mean difference.
Data Sharing Statement
The data underlying this article were provided by the Department of Information Center of our hospital under license. The data are not publicly available due to ethical restrictions.
Ethics Approval and Informed Consent
This study strictly adheres to the Helsinki Declaration, ensuring patient privacy and data confidentiality. We have established rigorous data management protocols, incorporating anonymization, authorized access, and thorough ethical review to guarantee full respect for patient rights. So, this study was approved by the Ethics Committee of Fuwai Hospital (NO.2020-1288, 31st December, 2020). Furthermore, the data were extracted from our hospital’s existing database, it was impractical to re-obtain all patients’ informed consent. Given that our study involves solely the analysis of anonymized data without any direct human intervention, we were exempted from the requirement for informed consent.
Consent for Publication
The details of any images, videos, recordings, etc. can be published.
Acknowledgments
The authors wish to thank Xu Wang for data curation.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors declare that there is no conflict of interest in this work.