Cardiothoracic & vascular anaesthesia
The TIMELESS Project: A Mixed-Methods Analysis of Modifiable Risk Factors and Transfusion Practices in 24,000 Cardiac Surgical Cases
Authors' conclusion
This large mixed-methods quality initiative identified modifiable risk factors, provider opinions, and transfusion behaviors to understand key drivers of transfusion in our cardiac surgery center.
Study context
- Population
- Adult cardiac surgical patients, January 2018–June 2024, at a high-volume cardiac surgery center; anesthesia, surgical and ICU front-line providers112 of 258 providers surveyed responded
- Participants
- 24,005 patients
- Outcome
- Total intraoperative and early postoperative blood product transfusion (association with modifiable risk factors)
Methodological detailsretrospective database analysis and provider survey, single-centre, structured provider survey
- Retrospective database analysis and provider survey
- Single-centre
- Structured provider survey
Main finding
As reported in the abstract
Risk-adjusted transfusion by modifiable risk factor
Incidence rate ratio (95% CI)
Preoperative anemia
1.74(1.67–1.83)
Malnutrition
1.44(1.36–1.54)
Perioperative hypothermia
1.66(1.59–1.73)
Hyperglycemiaper 10 mg/dL
1.02(1.02–1.02)
Antifibrinolytic therapyreduced transfusion
0.90(0.86–0.93)
Per 10 mg/dL, as printed
- Patients transfused during surgery and/or early postoperatively
- 13,420 (55.9%)
Observational data: associations, not effects.
Further findings
Transfusions given empirically without laboratory guidance
- Red blood cell (RBC)
- 32.1%
- Platelets
- 44.9%
- Cryoprecipitate
- 55.0%
- Plasma
- 82.4%
Provider survey
- Endorsed restrictive hemoglobin thresholds (<7.5 g/dL) for stable, non-bleeding patients
- 91/112, 81%
- Laboratory guidance omitted for urgent bleeding/coagulopathy
- 99/112, 88%
- Laboratory guidance omitted for prolonged surgical time
- 49/112, 44%
- Laboratory guidance omitted for long laboratory turnaround time
- 49/112, 44%
- Platelet and cryoprecipitate transfusion thresholds varied by specialty
Original publication
The TIMELESS Project: A Mixed-Methods Analysis of Modifiable Risk Factors and Transfusion Practices in 24,000 Cardiac Surgical Cases. Anesth Analg. Published 17 August 2026. doi:10.
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