Introduction: The type of cardiac surgery influences intraoperative transfusion needs due to differences in complexity, bypass duration, and bleeding risk. Understanding these patterns can improve perioperative planning and blood product use. This quality improvement project examined how surgery type relates to intraoperative transfusion of red blood cells (RBCs), platelets, fresh frozen plasma (FFP), and cryoprecipitate.
Methods: We retrospectively reviewed 24,005 adult patients who underwent cardiac surgery with or without cardiopulmonary bypass between January 2018 and June 2024. Procedures were grouped as isolated CABG, isolated valve surgery, CABG + valve, aortic repair, and combined CABG + valve + aortic cases (“three procedures”). Isolated double valve surgery was the reference group. Multivariable negative binomial regression was used to assess the association between procedure type and intraoperative transfusion, adjusting for anemia, reoperation, hypothermia, and other clinical variables.
Results: Transfusion rates differed significantly by procedure type. Aortic repairs and “three procedure” cases had the highest use of blood products and acute normovolemic hemodilution (5.9% and 8.9%, respectively). Compared to double valve cases, “three procedure” patients had 2.5 times more RBC use and over 3 times more platelet and cryoprecipitate use (all p< 0.001). CPB time >2 hours was associated with RBC transfusion in 72% of cases (median 3 units). Many transfusions lacked recent lab values: 81.9% of FFP, 54.7% of cryo, and 44.8% of platelets were given without a recent lab. Over half (57.2%) of RBCs were transfused at hemoglobin ≥7 g/dL. CPB time moderately correlated with transfusion volume (r=0.52).
Conclusions: In this quality improvement project, we reviewed transfusion practices across a large cardiac surgery population and found that procedure type was a major factor influencing intraoperative blood product use. More complex operations, especially those with longer bypass times, were associated with higher transfusion rates, often given without recent laboratory confirmation. These results support the need for procedure-specific transfusion guidelines to improve safety, reduce unnecessary product use, and enhance perioperative planning.
