Abstract
BackgroundPreoperative anemia and transfusion are associated with worse outcomes. This study aims to identify the prevalence of preoperative anemia, transfusion rates on surgery day, and predictors of transfusion in elective cardiac surgery patients at our centre. We also aim to evaluate our preoperative intervention program, and examine the intervention window for anemia before surgery.MethodsThis study included 797 adult patients who underwent elective cardiac surgery at a tertiary hospital. Multivariable logistic regression analysis was used to identify predictors of transfusion on surgery day.ResultsPreoperative anemia was present in 15% of patients. Anemic patients had a significantly higher transfusion rate at 53% compared to 10% in non-anemic patients. Hemoglobin concentration, estimated glomerular filtration rate (eGFR), body surface area (BSA), and total cardiopulmonary bypass time were predictive of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day, however, referral to the blood conservation clinic was only done for 8% of anemic patients and treatment was initiated in 3% of anemic patients. Among the 3 anemic patients who received treatment, 2 did not require blood transfusion on surgery day.ConclusionsPreoperative anemia is present in 15% of patients at our centre and these patients have 53% transfusion rates on surgery day. Hemoglobin concentration, eGFR, BSA, and total cardiopulmonary bypass time were predictors of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day. Referral and anemia treatment were infrequently initiated in preoperative anemic patient.
Highlights
Preoperative anemia and transfusion are associated with worse outcomes
Our study aims to determine the prevalence of anemia, transfusion rates on surgery day, and predictive factors of transfusion in patients undergoing elective cardiac surgery procedures at our institution
Transfusion rates and outcomes in elective cardiac surgery patients Anemic patients had a significantly higher transfusion rate at 53% compared to 10% in non-anemic patients (p < 0.0001) (Table 3)
Summary
Preoperative anemia and transfusion are associated with worse outcomes. This study aims to identify the prevalence of preoperative anemia, transfusion rates on surgery day, and predictors of transfusion in elective cardiac surgery patients at our centre. Blood transfusion in cardiac surgery is associated with increased morbidity and mortality, lengths of hospital stay, and health care costs [2, 9]. The relative contribution of preoperative anemia and RBC transfusion to the adverse outcomes in cardiac surgery patients remains uncertain, it has been shown that the interaction of the two increases morbidity and mortality far greater than the additive effects of each exposure individually [10, 12,13,14]. Recognizing the implications of preoperative anemia and perioperative transfusion, interventions to improve the hemodynamic status of patients before surgery have been implemented in multiple centres [15] These blood conservation programs have been shown to decrease transfusion rates, improve outcomes and reduce associated costs [2, 15]. Preoperative correction of anemia is an essential part of the blood management concept, and is recommended by major professional societies of cardiothoracic surgeons and anaesthesiologists [16,17,18]
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