Patient blood management protocol reduces allogeneic transfusion, morbidity, and mortality in coronary artery bypass surgery.

BACKGROUND

Allogeneic blood is a limited and globally scarce resource. Protocols based on the Patient Blood Management (PBM) program, incorporating therapeutic alternatives to reduce the use of red blood cells (RBCs), fresh frozen plasma (FFP), and platelet concentrates (PCs), have become urgently needed. The aims of this study were: as a primary objective, to evaluate whether the implementation of a PBM protocol reduces allogeneic transfusion in patients undergoing coronary artery bypass grafting (CABG); and as a secondary objective, to assess the impact of transfusion on clinical outcomes and mortality following CABG surgery.

METHODS

The study analyzed patients ≥ 18 years undergoing isolated and elective on-pump CABG, including both arterial and venous grafts. Data were retrospectively collected for two distinct periods, forming two groups: Pre-PBM (2010) and Post-PBM (2012), based on the implementation of a multidisciplinary PBM protocol aimed at optimizing erythropoiesis, hemostasis, and physiological tolerance to anemia. Statistical analyses included between-group comparisons, correlation analyses, and multiple regression to identify independent predictors of increased mortality. Statistical significance was defined as a p-value < 0.05.

RESULTS

A total of 3,564 patients undergoing CABG were stratified into the Pre-PBM (n = 2,150) and Post-PBM (n = 1,414) groups. Implementation of a PBM protocol was associated with a significantly reduced allogeneic transfusions-RBC (62.7% to 48.4%), FFP (13.1% to 6.7%), and PC (5.4% to 3.0%) (p < 0.001). Mortality decreased from 4.5% to 3.1% (p = 0.042), with lower deep sternal wound infection rates (p < 0.001). Transfusion was an independent risk factor for increased mortality, with RBC (OR 3.63, 95% CI 2.20-5.99, p < 0.001), FFP (OR 5.69, 95% CI 3.91-8.27, p < 0.001), and PC (OR 6.45, 95% CI 4.07-10.24, p < 0.001) therapy demonstrating a dose-dependent association. Even in low-risk patients (EuroSCORE ≤ 2), allogeneic transfusion was associated with a significantly higher mortality (p < 0.001).

CONCLUSIONS

Implementing a PBM protocol was associated with significant reductions in blood transfusions, infection rates, and mortality following CABG. Allogeneic transfusion was a strong predictor of adverse outcomes, including higher mortality, supporting the routine use of PBM strategies in CABG.