Abstract
BackgroundAnemia is an established adverse risk factor in cardiovascular disease. However, the effect of preoperative anemia is not well defined in heart surgery. This study evaluates the effect of preoperative anemia on early clinical outcomes in patients undergoing cardiac surgery.MethodsA retrospective, observational, cohort study of prospectively collected data was undertaken on 7,738 consecutive patients undergoing heart surgery between April 2003 and February 2009. Of these, 1,856 patients with preoperative anemia were compared to 5,882 patients without anemia (control group). According to the World Health Organization, anemia was defined as hemoglobin level < 13 g/dl for men and <12 g/dl for women. Selection bias not controlled by multivariable methods was assessed with propensity-adjustment method.ResultsOverall mortality was 2.1%. Preoperative anemia was associated with tripling in the risk of death (4.6% vs 1.5%, p < 0.0001) and postoperative renal dysfunction (18.5% vs 6.5%, p < 0.0001). There was also a significant difference between the anemic and non-anemic group in the risk of postoperative stroke (1.9% vs 1.1%, p = 0.008), atrial fibrillation (36.7% vs 33%, p = 0.003) and length of hospital stay > 7 days (54% vs 36.7%, p < 0.0001). In propensity-adjusted, multivariable logistic regression, preoperative anemia was an independent predictor of mortality (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.02 to 2.03), postoperative renal dysfunction (OR 1.73, 95% CI 1.43 to 2.1) and length of hospital stay > 7 days (OR 1.3, 95% CI 1.15 to 1.47).ConclusionIn patients undergoing heart surgery, preoperative anemia is associated with an increased risk of mortality and postoperative morbidity.
Highlights
Anemia is an established adverse risk factor in cardiovascular disease
Patients in the anemia group were older and more often female; they were more likely to have a greater prevalence of hypertension, chronic obstructive pulmonary disease, chronic kidney disease, extracardiac arteriophaty, and previous cardiac operations
The prevalence of patients undergoing other than isolated coronary artery bypass grafting (CABG) and aortic surgery were higher in the anemic patients than in the control group
Summary
The effect of preoperative anemia is not well defined in heart surgery. This study evaluates the effect of preoperative anemia on early clinical outcomes in patients undergoing cardiac surgery. Anemia is an established adverse risk factor for cardiovascular disease [1]. Several studies have shown that low levels of hemoglobin are associated with increased mortality and morbidity in elderly population, in patients with congestive heart failure and coronary artery disease, especially in the setting of acute coronary syndrome [2,3,4,5,6]. Previous investigations found preoperative anemia to be an independent risk factor of in-hospital mortality and morbidity after coronary artery bypass grafting (CABG) or valve surgery [7,8,9,10,11,12]. Others failed to demonstrate significant differences in adverse outcomes between patients with
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