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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 492-497, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
VA Ferraris and V Gildengorin
One hundred fifty-nine consecutive patients who underwent coronary artery
bypass grafting were studied to determine clinical and laboratory
predictors of excessive postoperative packed red blood cell transfusion.
Consideration of the distribution of packed red blood cells administered
revealed that the patients could be divided into two groups: those patients
who received 5 units of red blood cells or less (group I, n = 139) and
those patients who received more than 5 units of packed red blood cells
(group II, n = 20). The Mann-Whitney test or Fisher's exact test was used
whenever appropriate to test differences between these two groups with
respect to twelve patient variables. Patients in group II were found to
have a significantly longer preoperative template bleeding time and
decreased preoperative packed red blood cell volume (p less than 0.0008 for
both variables). In addition, group II patients were significantly older (p
= 0.026), were more likely to have had preoperative heparin therapy (p =
0.049), and contained a greater proportion of women (p = 0.0048). Of
interest, variables that did not achieve statistical significance between
groups were partial thromboplastin time, prothrombin time, platelet count,
preoperative hematocrit level, urgency of operation, recent ingestion of
aspirin, and recent heparin administration. All of the measured variables
were used in a stepwise logistic regression analysis to identify the best
predictors of the need for more than 5 units of packed red blood cells
after operation. Of the variables examined, bleeding time (p less than
0.001; chi 2 improvement = 15.1) and red blood cell volume (p = 0.009; chi
2 improvement = 6.8) were the best predictors of excessive postoperative
packed red blood cell use. On the basis of a 50% logistic probability
level, the specificity and sensitivity of these two variables in predicting
greater than a 5-unit transfusion requirement were 85% and 99%,
respectively. A clinically useful nomogram based on this logistic model is
presented. This nomogram suggests that a ratio of bleeding time to red
blood cell volume of 0.0071 or greater is associated with a greater than
70% chance of requiring more than 5 units of packed red blood cells. We
conclude that preoperative bleeding time and red blood cell volume are
useful predictors of excessive postoperative blood transfusion. These
results suggest that factors other than aspirin therapy may be associated
with bleeding time prolongation leading to excessive postoperative
transfusion.
ARTICLES
Predictors of excessive blood use after coronary artery bypass grafting. A multivariate analysis
Department of Surgery, Letterman Army Medical Center, Presidio of San Francisco, Calif. 94129-6700.
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