Impact of red blood cell transfusion on clinical outcomes after cardiovascular surgery: a reconstructed time-to-event meta-analysis
9 affiliations
- 1Lexington Medical Center, West Columbia, SC USA
- 2All India Institute of Medical Sciences, Guwahati, Assam India
- 3Lusíada University Center, Santos, São Paulo, Brazil
- 4Osmania Medical College, Hyderabad, Telangana India
- 5Bacha Khan Medical College, Mardan, Pakistan
- 6Kaiser Permanente Fontana Medical Center, Fontana, CA USA
- 7Chief, Department of Internal Medicine, Nasrat Bashir Curative Hospital, Kandahar, Afghanistan
- 8Division of Hematology and Oncology, Nassau University Medical Center, East Meadow, NY USA
- 9Department of Cardiothoracic Surgery, Cleveland Clinic Florida, Weston, FL USA
Abstract
Background: The impact of perioperative red blood cell transfusion on long-term outcomes after cardiovascular surgery remains controversial. This meta-analysis of reconstructed time-to-event data aimed to evaluate the association between red blood cell transfusion and clinical outcomes in adult patients undergoing cardiovascular surgery.
Methods: PubMed, Scopus, Embase, and the Cochrane Library were systematically searched for studies comparing perioperative red blood cell transfusion versus no transfusion in adults undergoing cardiovascular surgery. The primary endpoint was all-cause mortality at short- and long-term follow-up. A pairwise random-effects meta-analysis was done for 30-day mortality and other secondary outcomes, pooling risk ratios (RR) with 95% confidence intervals (CIs). Time-to-event data were reconstructed from published Kaplan–Meier curves to perform landmark analysis and estimate restricted mean survival time (RMST) differences between red blood cell transfused and non-transfused groups. Cox frailty regression analysis was used to obtain hazard ratios (HR). Meta-regression analyses were performed to explore sources of heterogeneity, and the certainty of evidence was assessed using the GRADE framework.
Results: This systematic review and meta-analysis included 15 observational studies (13 retrospective and 2 prospective) comparing the impact of red blood transfusion on cardiovascular outcomes in adult patients after cardiovascular surgery. Red blood cell transfusion was associated with a higher incidence of 30-day mortality (RR = 2.57, 95% CI [1.96, 3.38], I² = 0.0%, p < 0.001), long-term all-cause mortality (HR 1.79 (95% CI [1.75, 1.83]; p < 0.001)*, atrial fibrillation (RR 1.57 95% CI [1.21, 2.04]; p < 0.001), acute kidney injury (RR 4.52 95% CI [2.32, 8.80]; p < 0.001), myocardial infarction (RR 2.32 95% CI [1.60, 3.37]; p < 0.001), pneumonia (RR 5.10 95% CI [3.04, 8.57]; p < 0.001), reoperation for bleeding (RR 12.61 95% CI [7.99, 19.90]; p < 0.001), sepsis (RR 7.49 95% CI [2.64, 21.26]; p < 0.001), and stroke (RR 2.54 95% CI [2.04, 3.16]; p < 0.001).
Conclusions: These findings suggest that perioperative red blood cell transfusion was associated with higher rates of mortality and adverse outcomes; however, these findings should be interpreted cautiously because of residual confounding, baseline differences between groups, and the observational nature of the included studies.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13019-026-04549-0.
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BibTeX
@article{obi2026impact,
title = {{Impact of red blood cell transfusion on clinical outcomes after cardiovascular surgery: a reconstructed time-to-event meta-analysis}},
author = {Ogechukwu Samuel Obi and Vanisha Kumar and Gokul Rajith and Matheus S. Avila and Omer Farooq Mohammed and Asad Iqbal and Muhammad Khan and Uchenna Diane Nweze and Kamil Ahmad Kamil and Alida Podrumar and Michel Pompeu Sá},
journal = {Journal of Cardiothoracic Surgery},
year = {2026},
month = jul,
doi = {10.1186/s13019-026-04549-0},
url = {https://doi.org/10.1186/s13019-026-04549-0},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Impact of red blood cell transfusion on clinical outcomes after cardiovascular surgery: a reconstructed time-to-event meta-analysis
AU - Ogechukwu Samuel Obi
AU - Vanisha Kumar
AU - Gokul Rajith
AU - Matheus S. Avila
AU - Omer Farooq Mohammed
AU - Asad Iqbal
AU - Muhammad Khan
AU - Uchenna Diane Nweze
AU - Kamil Ahmad Kamil
AU - Alida Podrumar
AU - Michel Pompeu Sá
PY - 2026
DA - 2026/07/29
JO - Journal of Cardiothoracic Surgery
DO - 10.1186/s13019-026-04549-0
UR - https://doi.org/10.1186/s13019-026-04549-0
AB - Background: The impact of perioperative red blood cell transfusion on long-term outcomes after cardiovascular surgery remains controversial. This meta-analysis of reconstructed time-to-event data aimed to evaluate the association between red blood cell transfusion and clinical outcomes in adult patients undergoing cardiovascular surgery. Methods: PubMed, Scopus, Embase, and the Cochrane Library were systematically searched for studies comparing perioperative red blood cell transfusion versus no transfusion in adults undergoing cardiovascular surgery. The primary endpoint was all-cause mortality at short- and long-term follow-up. A pairwise random-effects meta-analysis was done for 30-day mortality and other secondary outcomes, pooling risk ratios (RR) with 95% confidence intervals (CIs). Time-to-event data were reconstructed from published Kaplan–Meier curves to perform landmark analysis and estimate restricted mean survival time (RMST) differences between red blood cell transfused and non-transfused groups. Cox frailty regression analysis was used to obtain hazard ratios (HR). Meta-regression analyses were performed to explore sources of heterogeneity, and the certainty of evidence was assessed using the GRADE framework. Results: This systematic review and meta-analysis included 15 observational studies (13 retrospective and 2 prospective) comparing the impact of red blood transfusion on cardiovascular outcomes in adult patients after cardiovascular surgery. Red blood cell transfusion was associated with a higher incidence of 30-day mortality (RR = 2.57, 95% CI [1.96, 3.38], I² = 0.0%, p < 0.001), long-term all-cause mortality (HR 1.79 (95% CI [1.75, 1.83]; p < 0.001)*, atrial fibrillation (RR 1.57 95% CI [1.21, 2.04]; p < 0.001), acute kidney injury (RR 4.52 95% CI [2.32, 8.80]; p < 0.001), myocardial infarction (RR 2.32 95% CI [1.60, 3.37]; p < 0.001), pneumonia (RR 5.10 95% CI [3.04, 8.57]; p < 0.001), reoperation for bleeding (RR 12.61 95% CI [7.99, 19.90]; p < 0.001), sepsis (RR 7.49 95% CI [2.64, 21.26]; p < 0.001), and stroke (RR 2.54 95% CI [2.04, 3.16]; p < 0.001). Conclusions: These findings suggest that perioperative red blood cell transfusion was associated with higher rates of mortality and adverse outcomes; however, these findings should be interpreted cautiously because of residual confounding, baseline differences between groups, and the observational nature of the included studies. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13019-026-04549-0.
SN - 1749-8090
ER -