Factors Associated with Blood Loss and Blood Product Transfusions

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Abstract
In this prospective cohort study of 548 children under- going open-heart surgery, we evaluated demographic and perioperative factors to identify variables associ- ated with perioperative blood loss and blood product transfusions. Using multivariate analysis, younger pa- tient age was found to be the variable most significantly associated with bleeding and transfusions. Higher pre- operative hematocrit, complex surgery, lower platelet count during cardiopulmonary bypass (CPB), and longer duration of deep hypothermic circulatory arrest were also significantly associated with bleeding and transfusion. Excessive postoperative chest tube (CT) drainage was associated with intraoperative bleeding. Independently associated variables accounted for 76% of the variability in CT output measured afte r2hi n intensive care. Patients were subdivided into children aged #1 yr (infants) and children .1 yr; infants bled more intraoperatively (P , 0.005); had greater cumula- tive CT output at 2, 6, 12, and 24 h (P , 0.0001); and received more blood products (P , 0.0001). Factors as- sociated with bleeding and transfusions varied with pa- tient age. Lower body core temperature during CPB was highly associated with blood loss and transfusions in infants, whereas resternotomy, preoperative conges- tive heart failure, and prolonged duration of CPB were significant factors associated with bleeding and trans- fusions in children .1 yr old. Implications: Knowledge of the factors associated with blood loss and blood product transfusions can help to identify children at risk of excessive bleeding after open-heart surgery. (Anesth Analg 1999;89:57-64)