Cardiovascular Anesthesiology Section Editor: Charles W. Houge, Jr. Cardiovascular and Thoracic Education Section Editor: Martin J. London Hemostasis and Transfusion Medicine Section Editor: Jerrold H. Levy The Association of Perioperative Red Blood Cell Transfusions and Decreased Long-Term Survival After Cardiac Surgery Stephen D. Surgenor, MD, MS* Robert S. Kramer, MD† Elaine M. Olmstead, BA‡ Cathy S. Ross, MS§§ Frank W. Sellke, MD§ Donald S. Likosky, PhD‡ Charles A. S. Marrin, MBBS* Robert E. Helm, Jr., MD Bruce J. Leavitt, MD¶ Jeremy R. Morton, MD† David C. Charlesworth, MD# Robert A. Clough, MD** Felix Hernandez, MD** Carmine Frumiento, MD†† Arnold Benak, CCP†† Christian DioData, CCP‡‡ Gerald T. O’Connor, PhD, DSc§§; For the Northern New England Cardiovascular Disease Study Group BACKGROUND: Exposure to red blood cell (RBC) transfusions has been associated with increased mortality after cardiac surgery. We examined long-term survival for cardiac surgical patients who received one or two RBC units during index hospitalization. METHODS: Nine thousand seventy-nine consecutive patients undergoing coronary artery bypass graft, valve, or coronary artery bypass graft/valve surgery at eight centers in northern New England during 2001–2004 were examined after exclu- sions. A probabilistic match between the regional registry and the Social Security Administration’s Death Master File determined mortality through June 30, 2006. Cox Proportional Hazard and propensity methods were used to calculate adjusted hazard ratios. RESULTS: Thirty-six percent of patients (n = 3254) were exposed to one or two RBC units. Forty-three percent of RBCs were given intraoperatively, 56% in the postoperative period and 1% were preoperative. Patients transfused were more likely to be anemic, older, smaller, female and with more comorbid illness. Survival was significantly decreased for all patients exposed to 1 or 2 U of RBCs during hospitalization for cardiac surgery compared with those who received none (P  0.001). After adjustment for patient and disease characteristics, patients exposed to 1 or 2 U of RBCs had a 16% higher long-term mortality risk (adjusted hazard ratios = 1.16, 95% CI: 1.01–1.34, P = 0.035). CONCLUSIONS: Exposure to 1 or 2 U of RBCs was associated with a 16% increased hazard of decreased survival after cardiac surgery. (Anesth Analg 2009;108:1741–6) There is growing evidence that transfusion of allogeneic red blood cells (RBCs) during management of cardiac surgical patients is associated with increased in-hospital morbidity and mortality. 1 Additionally, two groups have observed that patients exposed to RBC transfusion experi- enced decreased long-term survival after coronary artery bypass graft (CABG) surgery. 2,3 Similar observations of dose-dependent decreased long-term survival after RBC From the *Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; †Maine Medical Center, Portland, Maine; ‡Dartmouth Medical School, Hanover, New Hampshire; §Beth Israel Deaconess Medical Center, Boston, Massachusetts; Portsmouth Regional Hos- pital, Portsmouth, New Hampshire; ¶Fletcher Allen Health Care, Burlington, Vermont; #New England Heart Institute, Catholic Medi- cal Center, Manchester, New Hampshire; **Eastern Maine Medical Center, Bangor, Maine; ††Central Maine Medical Center, Lewiston, Maine; and ‡‡Concord Hospital, Concord, New Hampshire; §§The Dartmouth Institute for Health Policy and Clinical Practice, Dart- mouth College, Lebanon, New Hampshire. Accepted for publication February 19, 2009. There are no conflicts of interest for the author or co-authors. Address correspondence and reprint requests to Stephen D. Surgenor, MD, Dartmouth-Hitchcock Medical Center, Department of surgery, 1 Medical Center Drive Lebanon, NH 03756. Address e-mail to Stephen.D.Surgenor@Hitchcock. Copyright © 2009 International Anesthesia Research Society DOI: 10.1213/ane.0b013e3181a2a696 Vol. 108, No. 6, June 2009 1741