Abstract
This study aimed to evaluate the association between intraoperative blood loss and myocardial injury after non-cardiac surgery (MINS), which is a severe and common postoperative complication. We compared the incidence of MINS based on significant intraoperative bleeding, defined as an absolute hemoglobin level < 7 g/dL, a relative hemoglobin level less than 50% of the preoperative measurement, or need for packed red cell transfusion. We also estimated a threshold for intraoperative hemoglobin level associated with MINS. We stratified a total of 15,926 non-cardiac surgical patients with intraoperative hemoglobin and postoperative cardiac troponin (cTn) measurements according to the occurrence of significant intraoperative bleeding; 13,416 (84.2%) had no significant bleeding while 2,510 (15.8%) did have significant bleeding. After an adjustment with inverse probability weighting, the incidence of MINS was higher in the significant bleeding group (35.2% vs. 16.4%; odds ratio, 1.58; 95% confidence interval, 1.43-1.75; p < 0.001). The threshold of intraoperative hemoglobin associated with MINS was estimated to be 9.9 g/dL with an area under the curve of 0.643. Intraoperative blood loss appeared to be associated with MINS. Further studies are needed to confirm these findings. The cohort was registered before patient enrollment at https://cris.nih.go.kr (KCT0004244).
Highlights
Myocardial injury after non-cardiac surgery (MINS) has recently arisen as a strong predictor of postoperative mortality [1]
This study aimed to evaluate the association between intraoperative blood loss and myocardial injury after non-cardiac surgery (MINS), which is a severe and common postoperative complication
We stratified a total of 15,926 non-cardiac surgical patients with intraoperative hemoglobin and postoperative cardiac troponin measurements according to the occurrence of significant intraoperative bleeding; 13,416 (84.2%) had no significant bleeding while 2,510 (15.8%) did have significant bleeding
Summary
Myocardial injury after non-cardiac surgery (MINS) has recently arisen as a strong predictor of postoperative mortality [1]. Occurring in an estimated 8 million cases out of more than 200 million non-cardiac surgery patients every year, MINS has become the most common postoperative state related to mortality [2]. The compromised balance between oxygen supply/demand due to decreased hemoglobin levels and oxygen content is likely to be related to MINS [4], but the association between intraoperative blood loss and the occurrence of MINS has never been investigated. Intraoperative blood loss and decreased hemoglobin levels are independently associated with perioperative mortality and serious morbidity such as myocardial infarction, stroke, and renal failure [5,6,7]. This study aimed to evaluate the association between intraoperative blood loss and myocardial injury after non-cardiac surgery (MINS), which is a severe and common postoperative complication.
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