Introduction
Cardiac surgical procedures account for 10% to 15% of the 15 million units of red blood cells (RBCs) transfused in the United States annually.1 More than 32% of patients undergoing coronary artery bypass grafting (CABG) receive a transfusion.1 Blood transfusions and re-exploration for bleeding have been shown to increase mortality and major morbidity after cardiac surgery.2-8 Despite the potential risks from transfusions, prevalence of transfusions varies widely nationwide.9 Transfusion guidelines set forth by the Society of Thoracic Surgeons (STS) in 200710 and again in 201111 have not resulted in substantially decreased blood use in cardiac operations.1 The purpose of this study was to assess a multifaceted blood conservation and transfusion protocol developed and applied at a community hospital cardiac surgery program.