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Ann Thorac Surg 2006;82:13-20
© 2006 The Society of Thoracic Surgeons
Original article: Cardiovascular
Persistent Effect of Red Cell Transfusion on Health-Related Quality of Life After Cardiac Surgery
Colleen Gorman Koch, MD, MS a , * , Farah Khandwala, MS b , Liang Li, PhD b , Fawzy G. Estafanous, MD c , Floyd D. Loop, MD d , Eugene H. Blackstone, MD b , d
a Department of Cardiothoracic Anesthesia, The Cleveland Clinic Foundation, Cleveland, Ohio
b Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, Ohio
d Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
c Division of Anesthesia and Critical Care, The Cleveland Clinic Foundation, Cleveland, Ohio
Accepted for publication July 25, 2005.
* Address correspondence to Dr Koch, Department of Cardiothoracic Anesthesia (G-3), 9500 Euclid Ave, Cleveland, OH 44195 (Email: kochc@ccf.org ).
BACKGROUND: Although red blood cell transfusion has been associated with
an increase in early morbid outcomes and reduced long-term survival
after cardiac surgery, its relationship to functional quality
of life after surgery has not been previously explored. Our
objective was to investigate the relationship between perioperative
red blood cell and component transfusion and functional health-related
quality of life 6 to 12 months after cardiac surgery.
METHODS: Of 12,536 patients undergoing cardiac surgical procedures between
May 1995 and January 1999, 7,321 completed a self-administered
Duke Activity Status Index (DASI) survey preoperatively and
least one follow-up survey at nominally 6 or 12 months postoperatively.
The influence of baseline DASI, preoperative risk factors, clinical
status, laboratory values, operative events, and postoperative
morbidities on follow-up DASI were examined with ordinal regression
modeling.
RESULTS: After adjustment for preoperative DASI, demographic, cardiac
and noncardiac comorbidity, type of surgery, postoperative complications,
and interval between follow-up DASI, during which patients continued
to improve (
p < 0.0001), postoperative functional status
after cardiac surgery was incrementally worse the more perioperative
red cells (
p < 0.0001) and platelets (
p = 0.02) that had
been transfused.
CONCLUSIONS: Red blood cell and platelet transfusion have an unintended persistently
negative risk-adjusted effect on health-related quality of life
after cardiac surgery that extends well beyond initial hospitalization.
Reductions in functional recovery paralleled increasing units
of red blood cells transfused.
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