RBC transfusion and postoperative length of stay in the hospital or the intensive care unit among patients undergoing coronary artery bypass graft surgery: the effects of confounding factors

BACKGROUND: Data on the independent association between perioperative allogeneic blood transfusion (ABT) and postoperative length of stay at the hospital or in the intensive care unit (ICU) are sparse. STUDY DESIGN AND METHODS: The records of 421 consecutive patients undergoing coronary artery bypass graft (CABG) operations at the Massachusetts General Hospital were reviewed. The effect of perioperative ABT in explaining the variation in the postoperative length of stay (LOS) at the hospital or in the ICU was calculated after adjustment for the effects of 20 confounding factors that pertained to severity of illness, difficulty of operation, and risk of postoperative wound infection or pneumonia. RESULTS: Postoperative LOS averaged (mean +/- SE) 8.0 +/- 0.3 days in the hospital and 50.0 +/- 4.1 hours in the ICU. After adjustment for the effects of confounding factors, the postoperative length of hospitalization increased by 0.837 percent (95% CI, 0.249-1.425%) per RBC unit transfused (p<0.001), and the postoperative length of stay in the ICU increased by 0.873 percent (95% CI, -0.068-1.814%) per RBC unit transfused (p<0.10). CONCLUSION: Allogeneic blood transfusion was independently associated with longer postoperative stays in the hospital or the ICU, but the observed independent association is perhaps too small to be clinically relevant. This independent association may be due to a relationship between ABT and a higher incidence of septic complications of surgery, or it may reflect the function of blood transfusion as a surrogate marker for severity of illness.     

Large-volume leukapheresis in pediatric patients: processing more blood diminishes the apparent magnitude of intra-apheresis recruitment

Background: Recruitment of progenitors during a large-volume collection, as defined by increasing relative and absolute numbers of progenitors (colony-forming units-granulocyte-macrophage [CFU-GM] of CD34+ cells), has been reported previously. Study Design and Methods: To ascertain whether intra-apheresis recruitment occurs in pediatric patients who have undergone mobilization with chemotherapy and granulocyte-colony-stimulating factor (G-CSF), each hour's portion of a 4-hour leukapheresis was collected into separate bags, and assessed by complete blood count, CFU-GM, and CD34+ cell assays. Seven pediatric patients (median age, 7; range, 2–19) were studied in connection with 2 to 4 collections each, for a total of 21 collections (with hourly samples). The collections lasted for 4 hours, at an inlet rate of 1 to 3 mL per kg per minute, for daily processing totals of 5 to 12 blood volumes. (One blood volume [mL] is estimated by the patient's weight in kg × 70 mL/kg.) Smaller (younger) patients had inlet rates exceeding 2 mL per kg per minute, and larger (older) patients had rates of 1 to 1.5 mL per kg per minute. CFU-GM and CD34+ cell counts obtained each hour of the collection and divided by the first hour's value were compared by nonparametric repeated-measures ANOVA. Results: Second-, third- and fourth-hour CD34+ progenitor cell counts were arithmetically higher than first-hour counts, but the trend did not reach significance (p = 0.1561). Second-hour counts were higher than first-hour counts in the overall analysis (mean ± standard error [SE], 1.00 and 1.39 ± 0.1, respectively; p = 0.0525) and in children older than 5 years (1.00 vs. 1.70 ± 0.30, respectively; p = 0.0259), but not in children younger than 5 years (p = 0.8125). CFU-GM counts did not differ among the 4 hours of collection (p = 0.1717) or between the first and second hour (p = 0.9587). Conclusion: In larger (older) patients, from whom fewer blood volumes were collected, there is a trend toward intra-apheresis recruitment, although less than reported previously. In the smaller (younger) patients, from whom more blood volumes were collected, no trend was observed. Lack of (or submaximal) prior mobilization in previously reported studies may have facilitated intracollection recruitment. Alternatively, the larger number of blood volumes collected from the smaller (younger) patients may have masked intra-apheresis recruitment. The study documents the feasibility of large-volume, 4-hour leukapheresis in pediatric patients.     

The Hospital Anxiety and Depression Scale in Greek cancer patients: psychometric analyses and applicability

Goals of work The aim of the present study was to validate the Greek version of the Hospital Anxiety and Depression Scale (HAD) in a palliative care unit.Patients and methods The scale was translated with the forward-backward procedure to Greek. It was administered twice, with a 1-week interval, to 120 patients with advanced cancer. Together with the HAD scale, the patients also completed the Spielberger State-Anxiety Scale (STAI-S).Main results Factor analyses identified a two-factor solution corresponding to the original two subscales of the HAD, which were found to be correlated. The Greek version of the HAD had Cronbachs alphas for the anxiety and depression scales of 0.887 and 0.703, respectively. Validity as performed using known-group analysis showed good results. Both anxiety and depression subscales discriminated well between subgroups of patients differing in disease severity as defined by ECOG performance status. Correlations between the HAD scale and the STAI-S was 0.681 for the anxiety subscale and 0.485 for the depression subscale.Conclusions These psychometric properties of the Greek version of the HAD scale confirm it as a valid and reliable measure when administered to patients with advanced cancer.