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Previous Volume 358:1229-1239 March 20, 2008 Number 12 Next

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ABSTRACT

Background Stored red cells undergo progressive structural and functional changes over time. We tested the hypothesis that serious complications and mortality after cardiac surgery are increased when transfused red cells are stored for more than 2 weeks.

Methods We examined data from patients given red-cell transfusions during coronary-artery bypass grafting, heart-valve surgery, or both between June 30, 1998, and January 30, 2006. A total of 2872 patients received 8802 units of blood that had been stored for 14 days or less ("newer blood"), and 3130 patients received 10,782 units of blood that had been stored for more than 14 days ("older blood"). Multivariable logistic regression with propensity-score methods was used to examine the effect of the duration of storage on outcomes. Survival was estimated by the Kaplan–Meier method and Blackstone's decomposition method.

Results The median duration of storage was 11 days for newer blood and 20 days for older blood. Patients who were given older units had higher rates of in-hospital mortality (2.8% vs. 1.7%, P=0.004), intubation beyond 72 hours (9.7% vs. 5.6%, P<0.001), renal failure (2.7% vs. 1.6%, P=0.003), and sepsis or septicemia (4.0% vs. 2.8%, P=0.01). A composite of complications was more common in patients given older blood (25.9% vs. 22.4%, P=0.001). Similarly, older blood was associated with an increase in the risk-adjusted rate of the composite outcome (P=0.03). At 1 year, mortality was significantly less in patients given newer blood (7.4% vs. 11.0%, P<0.001).

Conclusions In patients undergoing cardiac surgery, transfusion of red cells that had been stored for more than 2 weeks was associated with a significantly increased risk of postoperative complications as well as reduced short-term and long-term survival.

Source Information

From the Department of Cardiothoracic Anesthesia (C.G.K.), the Department of Quantitative Health Sciences (L.L.), the Department of Outcomes Research (C.G.K., D.I.S.), the Department of Laboratory Medicine and Clinical Pathology (P.F., G.A.H.), and the Department of Thoracic and Cardiovascular Surgery (T.M., E.H.B.), Cleveland Clinic Foundation, Cleveland.

Address reprint requests to Dr. Koch at the Departments of Cardiothoracic Anesthesia and Outcomes Research, Cleveland Clinic, 9500 Euclid Ave. G3, Cleveland, OH 44195, or at kochc{at}ccf.org.

Full Text of this Article

Related Letters:

Red-Cell Storage and Complications of Cardiac Surgery
Benjamin R. J., Dodd R. Y., Hall S. W., Habib R. H., Zacharias A., Frenzel T., Sibrowski W., Westphal M., Koch C. G., Li L., Blackstone E. H.
Extract | Full Text | PDF  
N Engl J Med 2008; 358:2840-2842, Jun 26, 2008. Correspondence

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