Preoperative Anemia Correction in Cardiac Surgery: A Propensity-Matched Study

Abstract

Abstract Objective Preoperative anemia is a risk factor for transfusions, morbidity and mortality in cardiac surgery. The aim of this study is to assess if an anemia intervention strategy before cardiac surgery is associated with reduced red blood cell (RBC) transfusion. Design Retrospective, propensity matched study Setting. University Clinical Research Hospital. Participants: two-hundred-twenty-eight adult cardiac surgery patients. Propensity matching was based on demographics, pre-treatment hemoglobin value, congestive heart failure, active endocarditis, serum creatinine, serum bilirubin, redo surgery, non-elective surgery, non-isolated surgery. Interventions Patients in the treated group received an anemia correction treatment at the pre-admission anesthesia clinic examination. The treatment included ferric carboxymaltose and/or erythropoietin based on the anemia diagnosis (absolute sideropenic; functional sideropenic; anemia of chronic disease). Treatment was single shot, at a median of 13 preoperative days (interquartile range 9-17 days. Patients in the control group were selected by propensity matching and did not receive any treatment. Measurements and Main Results Patients in the treated group received RBC transfusion in 61.4% of the cases vs. 76.3% in control group (odds ratio 0.49, 95% confidence interval 0.26-0.84, P=0.010) and a median units load of 1 unit (interquartile range 0-2) vs. 2 units (interquartile range 1-3) in control group (P=0.001). Patients in the treated group had significantly lower chest drain output, postoperative low cardiac output rate, and shorter intensive care and hospital stay. Conclusions Anemia correction before cardiac surgery is associated with a reduction in both the RBC transfusion rate and the amount of units transfused.