ANALYSIS OF MORBIMORTALITY ASSOCIATED WITH PERIOPERATIVE BLOOD TRANSFUSIONS IN PATIENTS UNDERGOING CARDIAC SURGERY

• Grant number: 23/09571-2
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: March 01, 2024
• End date: February 28, 2025
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Nelson Americo Hossne Junior
• Grantee: Luis Felipe Ferraz de Oliveira
• Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil

Abstract

Blood transfusions are widely used as a therapeutic resource in various clinical situations, including cardiac surgeries. However, evidence suggests that transfusions are often administered excessively and without precise indication, which can result in adverse effects and complications for the patient. In this context, it is essential to encourage the reduction of indiscriminate use of blood transfusions, seeking scientific evidence to support clinical decision-making. Specifically in cardiac surgeries, it is crucial to understand how blood transfusions can affect the surgical outcomes of patients. There are specific factors that can potentiate the negative effects of blood transfusions, such as the volume and type of blood component used during the surgical procedure. Therefore, it is necessary to study this relationship to identify the impacts of blood transfusions and develop more effective and safe guidelines for their use in cardiovascular surgeries. The objective of this study is to examine the relationship between the administration of blood components during the intraoperative period of cardiac surgeries, considering the volume and type of blood component used, and the clinical outcomes such as length of hospital stay, risk of infection, need for reoperation, postoperative atrial fibrillation, bleeding, use of vasoactive drugs, and mortality. Additionally, confounding factors that may influence the results will be considered. Information will be collected from 50 patients undergoing cardiac surgeries at Hospital São Paulo (HSP), by the Discipline of Cardiovascular Surgery of Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), during the year 2023. The information will be obtained from the patient's electronic medical record, with authorization from the Research Ethics Committee (CEP) and the responsible department. Data collection will include demographic information for sample characterization, such as gender, ethnicity, education level, family history of diseases, and medications used. Additionally, dependent variables (DV) and independent variables (IV) will be collected for the analysis of the association between blood components and clinical outcomes, along with possible confounding factors for this association. The analyzed IVs will be the type of transfused blood component and the volume of transfused blood component. The IVs considered as possible confounding factors will include the presence of diabetes, left ventricular ejection fraction, preoperative anemia, previous length of hospital stay, use and length of extracorporeal circulation (ECC) during surgery, operative risk indices (such as STS score II and EUROSCORE), and surgical team. The analyzed DVs will be length of hospital stay, surgical site infection, need for reoperation, mortality, postoperative atrial fibrillation, bleeding, and use of vasoactive drugs. These outcomes will allow evaluating the impacts of blood transfusions on the clinical progression of patients undergoing cardiac surgeries. The obtained results will be fundamental to improve medical practices related to the use of blood transfusions in cardiovascular procedures, contributing to the definition of more effective and safe guidelines. It is expected that this research will promote a clearer understanding of the impact of blood transfusions on the clinical progression of patients and assist in making more informed clinical decisions.