DETERMINANTS OF RED-CELL, PLATELET, PLASMA, AND CRYOPRECIPITATE TRANSFUSIONS DURING CORONARY-ARTERY BYPASS GRAFT-SURGERY - THE COLLABORATIVE HOSPITAL TRANSFUSION STUDY

Background: Very little is known about the determinants of blood trans fusions in patients undergoing coronary artery bypass graft surgery. S tudy Design and Methods: To identify factors that influenced the trans fusion of red cells, platelets, plasma, and cryoprecipitate, statistic al methods were used to study 2476 consecutive diagnosis-related group 106 and 107 patients in five teaching hospitals who underwent coronar y artery bypass surgery between January 1, 1992, and June 30, 1993. Re sults: The likelihood of red cell transfusion was significantly associ ated with 10 preoperative factors: 1) admission hematocrit, 2) the pat ient's age, 3) the patient's gender, 4) previous coronary artery bypas s surgery, 5) active tobacco use, 6) catheterization during the same a dmission, 7) coagulation defects, 8) insulin-dependent diabetes with r enal or circulatory manifestations, 9) first treatment of new episode of transmural myocardial infarction, and 10) severe clinical complicat ions, Platelet and/or plasma transfusions were strongly associated wit h the dose of red cells transfused. Transfusion requirements and other in-hospital outcomes were associated with patient characteristics, su rgical procedure (reoperation vs. primary procedure), and the conduits used for revascularization (venous graft only, venous and internal ma mmary artery graft, or internal mammary artery graft only). Blood reso urce use and donor exposures were evaluated with respect to the risk t o patients of contracting hepatitis C virus and human immunodeficiency virus infections. Conclusion: The classification of coronary artery b ypass graft patients on the basis of attributes known preoperatively a nd by conduits used yields subsets of patients with distinctly differe nt transfusion requirements and in-hospital outcomes.