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Perioperative 1- to 2-Unit Red Blood Cell Transfusion Is Associated with Decreased Short-Term, but Not Long-Term Survival

Section Editor(s): Saidman, LawrenceSurgenor, Stephen D. MD; Marrin, Charles A. S. MD; Leavitt, Bruce J. MD; Morton, Jeremy R. MD; Kramer, Robert S. MD; Olmstead, Elaine M. BA; Ross, Cathy S. MS; Charlesworth, David C. MD; Clough, Robert A. MD; Hernandez, Felix Jr. MD; Selke, Frank W. MD; Likosky, Donald S. PhD; Helm, Robert E. Jr. MD; O'Connor, Gerald T. PhD

doi: 10.1213/ANE.0b013e3181ca4c6d
Letters to the Editor: Letters & Announcements

Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, stephen.d.surgenor@hitchcock

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In Response:

In response to the letter by Drs. Gibbs and Weightman,1 our goal was to report2 5-year survival for a restricted group of cardiac surgical patients exposed to small quantities of red blood cell (RBC) transfusions (1 or 2 U) compared with those with no exposure during their index cardiac surgery admission. We applied restrictive exclusion criteria to remove patients experiencing active hemorrhage or other conditions that could limit survival separate from the exposure of interest, RBC transfusion. We used both Cox proportional hazards modeling and propensity-adjusted analysis to assess the effect of exposure. We observed a statistically significant 16% increased adjusted risk of 5-year mortality with both statistical methods. Upon closer examination, we observed that the effect on survival was most pronounced in the first 6 months after surgery, with 67% increased risk of 6-month mortality. Regardless of how one chooses to define “short-term” versus “long-term” survival, we observed an association of markedly reduced survival after cardiac surgery after exposure to small quantities of RBC transfusion.

Stephen D. Surgenor, MD

Department of Surgery

Dartmouth-Hitchcock Medical Center

Lebanon, New Hampshire


Charles A. S. Marrin, MD

Bruce J. Leavitt, MD

Jeremy R. Morton, MD

Robert S. Kramer, MD

Elaine M. Olmstead, BA

Cathy S. Ross, MS

David C. Charlesworth, MD

Robert A. Clough, MD

Felix Hernandez, Jr., MD

Frank W. Selke, MD

Donald S. Likosky, PhD

Robert E. Helm, Jr., MD

Gerald T. O'Connor, PhD

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1.Gibbs NM, Weightman WM. Perioperative 1–2 unit red blood cell transfusion is associated with decreased short-term, but not long-term survival. 2010;110:971–2
2.Surgenor SD, Kramer RS, Olmstead EM, Ross CS, Sellke FW, Likosky DS, Marrin CAS, Helm RE, Leavitt BJ, Morton JR, Charlesworth DC, Clough RA, Hernandez F, Frumiento C, Benak A, DioData C, O'Connor GT. The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg 2009;108:1741–6
© 2010 International Anesthesia Research Society