Association of perioperative cryoprecipitate transfusion and mortality after cardiac surgery.

Abstract

Cryoprecipitate is often transfused in patients undergoing cardiac surgery. However, its safety and effectiveness remains uncertain. We conducted a propensity-score matched analysis of data from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database. We included adults undergoing cardiac surgery between 2005-2018 across 38 sites. We estimated the association between perioperative cryoprecipitate transfusion and clinical outcomes, with a primary outcome of operative mortality. Of 119,132 eligible patients, 11,239 (9.43%) patients received cryoprecipitate. The median cumulative dose was 8 units (interquartile range, 5 to 10). After propensity-score matching, we matched 9,055 cryoprecipitate recipients to 9,055 controls. Postoperative cryoprecipitate transfusion was associated with reduced operative (Odds Ratio [OR], 0.82; 99% confidence interval [CI], 0.69 to 0.97; P=0.002) and long term (Hazard Ratio, 0.92; 99% CI, 0.87 to 0.97; P=0.0042) mortality. It was also associated with a reduction in acute kidney injury (OR, 0.85; 99% CI, 0.73 to 0.98; P=0.0037] and all-cause infection (OR, 0.77; 99% CI, 0.67 to 0.88; P<0.0001). These findings were observed despite increased rates of return to operating theatre (OR, 1.36; 99% CI, 1.22 to 1.51; P<0.0001) and cumulative 4-hour postoperative chest tube output (Adjusted Mean Difference in mL, 97.69; 99% CI, 81.65 to 113.74; P<0.0001). In a large, multicentre cohort study and after propensity-score matching, perioperative transfusion of cryoprecipitate was associated with reduced operative and long-term mortality.