Intraoperative allogeneic blood requirement in cardiac surgery. Analysis of 7.729 patients from 12 cardiosurgical centers in Germany

Allogeneic blood requirement in cardiac surgery shows a wide variation even for comparable procedures. The aim of the present study was to compare the intraoperative allogeneic blood requirement in defined cardiac operations among 12 cardiac centers in Germany. Method: A data set with 25 variables concerning the intraoperative course i n adult cardiac patients with myocardial revascularization, valve replaceme nt (aortic or/and mitral valve) or combined procedures was distributed to t he participating centers. The data of all patients between January 1(th) 19 98 and June 30(th) 1998 were included. Besides demographic data, the intrao perative transfusion of allogeneic and autologous blood, fresh frozen plasm a and the concomitant hematocrit values were registered. Data were analyzed for all centers and separated for each center. Results: The data of 7.729 patients were analyzed. The intraoperative allog eneic blood requirement was 0.6+/-1.3 units for all patients. It varied amo ng the centers from 0.25+/-0.6 units to 0.97+/-1.6 units (P<0.05). The perc entage of patients receiving allogeneic blood was 27% and differed among th e centers from 17% to 35%. Female patients were transfused in 53% (36-39%) compared to male patients with 16% (9-20%) (P<0.05). The rate of autologous blood pre-donation varied from 0.5% to 23%. Patients without autologous pr edonation were transfused in 28% compared to 4% in patients with predonatio n (P<0.05). In patients with autologous predonation the intraoperative tran sfusion of allogeneic blood was significantly reduced (0.1+/-0.39 vs 0.6+/- 1.4 units, P<0.05). However, some centers with a high percentage of autolog ous predonation also demonstrated a high rate of perioperative allogeneic t ransfusion. Conclusion:The incidence of allogeneic blood transfusion in cardiac surgery depends on the institution and not on the surgical procedure. A common thr eshold value of hemoglobin for the transfusion of blood trigger even for co mparable procedures could not be detected among the centers. Especially in female patients, there was a wide variation in allogeneic blood transfusion . Autologous blood predonation reduces blood requirement significantly, how ever, it is practiced with variing intensity. The data set did not include information about transfusion regimen in the postoperative period, thus, th ese data do not allow to draw conclusions for the whole perioperative perio d.