103 Preoperative anemia is a risk factor for mortality and morbidity following aortic valve surgery

Abstract

Listen

Translate article

BackgroundAnemic patients have been shown to have poorer outcome following non-cardiac surgery as well as coronary artery bypass surgery. However, the impact of anemia on patients undergoing aortic valve surgery has not been well studied. We sought to evaluate the effect of anemia on early outcomes following aortic valve surgery.MethodsAll patients undergoing non emergent aortic valve surgery (n = 2698) with or without other concomitant procedures between 1997 to 2010 were included. Preoperative anemia was defined as per World Health Organization guidelines as hemoglobin (Hb) <130 g/L in men and Hb<120 g/L in women. Multivariable analyses were used to determine the association between anemia and postoperative outcome.ResultsThe prevalence of preoperative anemia was 32.2%. Patients with anemia were older (71±12 years versus 66±13, P < 0.001), more likely to have urgent surgery, recent MI, higher creatinine level and impaired preoperative left ventricular function. Overall unadjusted mortality was 2.8% in non-anemic patients versus 7.97 % in anemic patients. Anemic patients were more likely to require renal replacement therapy (11% versus 3%, P < 0.0001), and prolonged ventilation (24% versus 10%, P < 0.0001). Lower preoperative hemoglobin was an independent predictor of mortality (odds ratio 1.19, 95% CI, 1.04 - 1.34, P = 0.007) and composite morbidity (odds ratio 1.36, 95% CI, 1.05 - 1.77, P = 0.02) after AVR. (Table 1). Mortality and composite morbidity were significantly higher with lower levels of preoperative hemoglobin (Figure 1).Tabled 1View Large Image Figure ViewerDownload Hi-res image Download (PPT)ConclusionPreoperative anemia is a common finding in patients undergoing aortic valve surgery and is an important and potentially modifiable risk factor for post-operative morbidity and mortality. BackgroundAnemic patients have been shown to have poorer outcome following non-cardiac surgery as well as coronary artery bypass surgery. However, the impact of anemia on patients undergoing aortic valve surgery has not been well studied. We sought to evaluate the effect of anemia on early outcomes following aortic valve surgery. Anemic patients have been shown to have poorer outcome following non-cardiac surgery as well as coronary artery bypass surgery. However, the impact of anemia on patients undergoing aortic valve surgery has not been well studied. We sought to evaluate the effect of anemia on early outcomes following aortic valve surgery. MethodsAll patients undergoing non emergent aortic valve surgery (n = 2698) with or without other concomitant procedures between 1997 to 2010 were included. Preoperative anemia was defined as per World Health Organization guidelines as hemoglobin (Hb) <130 g/L in men and Hb<120 g/L in women. Multivariable analyses were used to determine the association between anemia and postoperative outcome. All patients undergoing non emergent aortic valve surgery (n = 2698) with or without other concomitant procedures between 1997 to 2010 were included. Preoperative anemia was defined as per World Health Organization guidelines as hemoglobin (Hb) <130 g/L in men and Hb<120 g/L in women. Multivariable analyses were used to determine the association between anemia and postoperative outcome. ResultsThe prevalence of preoperative anemia was 32.2%. Patients with anemia were older (71±12 years versus 66±13, P < 0.001), more likely to have urgent surgery, recent MI, higher creatinine level and impaired preoperative left ventricular function. Overall unadjusted mortality was 2.8% in non-anemic patients versus 7.97 % in anemic patients. Anemic patients were more likely to require renal replacement therapy (11% versus 3%, P < 0.0001), and prolonged ventilation (24% versus 10%, P < 0.0001). Lower preoperative hemoglobin was an independent predictor of mortality (odds ratio 1.19, 95% CI, 1.04 - 1.34, P = 0.007) and composite morbidity (odds ratio 1.36, 95% CI, 1.05 - 1.77, P = 0.02) after AVR. (Table 1). Mortality and composite morbidity were significantly higher with lower levels of preoperative hemoglobin (Figure 1).Tabled 1 The prevalence of preoperative anemia was 32.2%. Patients with anemia were older (71±12 years versus 66±13, P < 0.001), more likely to have urgent surgery, recent MI, higher creatinine level and impaired preoperative left ventricular function. Overall unadjusted mortality was 2.8% in non-anemic patients versus 7.97 % in anemic patients. Anemic patients were more likely to require renal replacement therapy (11% versus 3%, P < 0.0001), and prolonged ventilation (24% versus 10%, P < 0.0001). Lower preoperative hemoglobin was an independent predictor of mortality (odds ratio 1.19, 95% CI, 1.04 - 1.34, P = 0.007) and composite morbidity (odds ratio 1.36, 95% CI, 1.05 - 1.77, P = 0.02) after AVR. (Table 1). Mortality and composite morbidity were significantly higher with lower levels of preoperative hemoglobin (Figure 1). ConclusionPreoperative anemia is a common finding in patients undergoing aortic valve surgery and is an important and potentially modifiable risk factor for post-operative morbidity and mortality. Preoperative anemia is a common finding in patients undergoing aortic valve surgery and is an important and potentially modifiable risk factor for post-operative morbidity and mortality.