• Pey-Jen Yu, Hugh A Cassiere, Sophia L Dellis, Rick A Esposito, Nina Kohn, Donna LaConti, and Alan R Hartman.
• North Shore University Hospital. Electronic address: pyu2@nshs.edu.
• J. Cardiothorac. Vasc. Anesth.. 2014 Dec 1;28(6):1545-9.

ObjectiveTo determine the incremental risk associated with each intraoperative red blood cell transfusion in cardiac surgery patients.DesignRetrospective analysis on prospectively collected data.SettingSingle tertiary care hospital.ParticipantsSeven hundred forty-five patients undergoing on-pump cardiac surgery between January 2010 and June 2012 who received between 1 and 3 units of red blood cell transfusion intraoperatively.InterventionsAll patients received between 1 and 3 units of red blood cell transfusions. All transfusions were with leukoreduced blood that had been stored for < 14 days.Measurements And Main ResultsPostoperative complications and length of intubation were associated with the number of red blood cell units transfused. Transfusion of each additional unit of red blood cells was associated with incrementally worse outcomes. Median length of intubation was 11 hours, 12 hours, and 13 hours in patients receiving 1, 2, and 3 units of red blood cell transfusions, respectively (p < 0.005). Similarly, each additional unit of red blood cell transfusion was associated with increasing postoperative septicemia (0% v 0.35% v 2.29%, p < 0.006) and postoperative pneumonia (0% v 0.70% v 2.29%, p < 0.013).ConclusionsThere is a step-wise increase in length of postoperative intubation with each red blood cell transfusion in patients undergoing cardiac surgery. Each additional unit of intraoperative RBC transfusion also may increase postoperative infectious complications. Thus, even single-unit reductions in red blood cell transfusions may have significant impact on outcomes.Copyright © 2014 Elsevier Inc. All rights reserved.

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