Background: A new transfusion guideline was developed to reduce the number of unnecessary blood preparations and transfusions as well as the complications associated with transfusions in an off-pump coronary artery bypass (OPCAB) procedure. The results were compared with those using existing guidelines.

METHODS: The patients who had undergone an elective OPCAB were divided into 2 groups. In group A (n = 70, with existing transfusion guideline), the anesthesiologists transfused to a Hemoglobin (Hb) level of 8.0-10.0 g/dl based on the decisions of the anesthesiologists or surgeons. In group B (n = 102, using new transfusion guideline), the transfusion was performed to a Hb of 8.0 g/dl. The number of preoperative blood preparations, transfusions, and wastage were evaluated, and the Hb concentrations were examined preoperatively, postoperatively, at discharge, and 2 weeks after surgery. The incidence of postoperative complications in the two groups was compared.

RESULTS: There was no significant difference in the preoperative, intraoperative, and postoperative minimal Hb concentrations between the two groups. However, the Hb concentrations in group B on the day after surgery, at discharge, and 2 weeks after surgery were significantly lower than those in the control group (P < 0.001); the Hb was > 10.0 g/dl in group B (minimum Hb 10.4 g/dl). The rate of bloodless OPCAB increased from 2% to 57%. There was a similar number of blood restorations and wastage, incidence of wound infections, bleeding, arrhythmias, myocardial infarctions, sudden death, length of the ICU stay and postoperative admissions in the two groups.

CONCLUSIONS: With the new transfusion guideline, number of P-RBC preparations and transfusions was decreased significantly without an increase in the incidence of complications.