Skip to main content

Advertisement

SpringerLink
Log in

Preoperative anemia and anemia treatment in cardiac surgery: a systematic review and meta-analysis

Anémie préopératoire et traitement de l’anémie en chirurgie cardiaque : une revue systématique et méta-analyse

  • Review Article/Brief Review
  • Published:
Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

We aimed to conduct a systematic review and meta-analysis to assess the effects of anemia and anemia severity on patient outcomes in cardiac surgery and determine whether preoperative treatments confer postoperative benefit.

Source

We searched four international databases for observational and randomized studies published until 1 October 2022. Study quality was assessed via Newcastle–Ottawa scores and the Cochrane Risk-of-Bias 2 tool and certainty of evidence was rated with the Grading of Recommendations, Assessment, Development and Evaluations approach. We conducted random-effects meta-analyses for our primary outcome of mortality, for secondary outcomes including length of stay (LOS) in the hospital and intensive care unit, and for postsurgical complications. As part of a secondary analysis, we analyzed short-term preoperative anemia treatments and conducted trial sequential analysis of randomized trials to assess the efficacy of these treatment programs.

Principal findings

We included 35 studies (159,025 patients) in our primary meta-analysis. Preoperative anemia was associated with increased mortality (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.2 to 2.9; P < 0.001, high certainty). Study-level meta-regression revealed lower hemoglobin levels and studies with lower proportions of male patients to be associated with increased risk of mortality. Preoperative anemia was also associated with an increase in LOS and postsurgical complications. Our secondary analysis (seven studies, 1,012 patients) revealed short-term preoperative anemia treatments did not significantly reduce mortality (OR, 1.1; 95% CI, 0.65 to 1.9; P = 0.69). Trial sequential analysis suggested that there was insufficient evidence to conclude if treatment programs yield any benefit or harm.

Conclusions

Preoperative anemia is associated with mortality and morbidity after cardiac surgery. More research is warranted to test the efficacy of current anemia treatment programs.

Study registration

PROSPERO (CRD42022319431); first submitted 17 April 2023.

Résumé

Objectif

Notre objectif était de mener une revue systématique et une méta-analyse pour évaluer les effets de l’anémie et de la gravité de l’anémie sur les devenirs des patient·es en chirurgie cardiaque et déterminer si les traitements préopératoires conféraient un bénéfice postopératoire.

Sources

Nous avons réalisé des recherches dans quatre bases de données internationales pour en extraire des études observationnelles et randomisées publiées jusqu’au 1er octobre 2022. La qualité des études a été évaluée à l’aide des scores de Newcastle-Ottawa et de l’outil Cochrane 2 sur le risque de biais, et la certitude des données probantes a été évaluée selon l’approche GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Nous avons réalisé des méta-analyses à effets aléatoires pour notre critère d’évaluation principal de mortalité, pour les critères d’évaluation secondaires, notamment la durée du séjour à l’hôpital et à l’unité de soins intensifs, et pour les complications postopératoires. Dans le cadre d’une analyse secondaire, nous avons examiné les traitements préopératoires de l’anémie à court terme et effectué une analyse séquentielle d’études randomisées afin d’évaluer l’efficacité de ces modalités de traitement.

Constatations principales

Nous avons inclus 35 études portant sur 159 025 patient·es dans notre méta-analyse. L’anémie préopératoire était associée à une augmentation de la mortalité (rapport de cotes [RC], 2,5; intervalle de confiance [IC] à 95 %, 2,2 à 2,9; P < 0,001, certitude élevée). La méta-régression au niveau de l’étude a révélé que des taux d’hémoglobine plus faibles et des études avec des proportions plus faibles de patients masculins étaient associées à un risque accru de mortalité. L’anémie préopératoire était également associée à une augmentation de la durée de séjour et des complications postopératoires. Notre analyse secondaire (sept études, 1012 patient·es) a révélé que les traitements préopératoires de l’anémie à court terme ne réduisaient pas significativement la mortalité (RC, 1,1; IC 95 %, 0,65 à 1,9; P = 0,69). L’analyse séquentielle des études a suggéré qu’il n’y avait pas suffisamment de données probantes pour conclure si les modalités de traitement entraînaient un bénéfice ou un préjudice.

Conclusion

L’anémie préopératoire est associée à la mortalité et à la morbidité après une chirurgie cardiaque. D’autres recherches sont justifiées pour tester l’efficacité des programmes actuels de traitement de l’anémie.

Enregistrement de l’étude

PROSPERO (CRD42022319431); première soumission le 17 avril 2023.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Veluz JS, Leary MC. Chapter 126 - Cerebrovascular Complications of Cardiac Surgery. In: Caplan LR, Biller J, Leary MC, et al., eds. Primer on Cerebrovascular Diseases (Second Edition). San Diego: Academic Press, 2017: 650–5.

    Chapter  Google Scholar 

  2. O’Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery. Ann Thorac Surg 2009; 88: S23–42. https://doi.org/10.1016/j.athoracsur.2009.05.056

    Article  PubMed  Google Scholar 

  3. Vogt A, Grube E, Glunz HG, et al. Determinants of mortality after cardiac surgery: results of the registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10 525 patients. Eur Heart J 2000; 21: 28–32. https://doi.org/10.1053/euhj.1999.1634

    Article  CAS  PubMed  Google Scholar 

  4. Mazzeffi M, Zivot J, Buchman T, Halkos M. In-hospital mortality after cardiac surgery: patient characteristics, timing, and association with postoperative length of intensive care unit and hospital stay. Ann Thorac Surg 2014; 97: 1220–5. https://doi.org/10.1016/j.athoracsur.2013.10.040

    Article  PubMed  Google Scholar 

  5. Sanders J, Cooper JA, Farrar D, et al. Pre-operative anaemia is associated with total morbidity burden on days 3 and 5 after cardiac surgery: a cohort study. Perioper Med (Lond) 2017; 6: 1. https://doi.org/10.1186/s13741-017-0057-4

    Article  PubMed  Google Scholar 

  6. Shander A, Javidroozi M, Ozawa S, Hare GM. What is really dangerous: anaemia or transfusion? Br J Anaesth 2011; 107: i41–59. https://doi.org/10.1093/bja/aer350

    Article  PubMed  Google Scholar 

  7. Ucar HI, Oc M, Tok M, et al. Preoperative fibrinogen levels as a predictor of postoperative bleeding after open heart surgery. Heart Surg Forum 2007; 10: E392–6. https://doi.org/10.1532/hsf98.20071065

    Article  PubMed  Google Scholar 

  8. Gielen C, Dekkers O, Stijnen T, et al. The effects of pre- and postoperative fibrinogen levels on blood loss after cardiac surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2013; 18: 292–8. https://doi.org/10.1093/icvts/ivt506

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dai L, Mick SL, McCrae KR, et al. Preoperative anemia in cardiac operation: does hemoglobin tell the whole story? Ann Thorac Surg 2018; 105: 100–7. https://doi.org/10.1016/j.athoracsur.2017.06.074

    Article  PubMed  Google Scholar 

  10. Vivacqua A, Koch CG, Yousuf AM, et al. Morbidity of bleeding after cardiac surgery: is it blood transfusion, reoperation for bleeding, or both? Ann Thorac Surg 2011; 91: 1780–90. https://doi.org/10.1016/j.athoracsur.2011.03.105

    Article  PubMed  Google Scholar 

  11. Juffermans NP, Prins DJ, Vlaar AP, Nieuwland R, Binnekade JM. Transfusion-related risk of secondary bacterial infections in sepsis patients: a retrospective cohort study. Shock 2011; 35: 355–9. https://doi.org/10.1097/shk.0b013e3182086094

    Article  PubMed  Google Scholar 

  12. Nuis RJ, Van Mieghem NM, Tzikas A, et al. Frequency, determinants, and prognostic effects of acute kidney injury and red blood cell transfusion in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2011; 77: 881–9. https://doi.org/10.1002/ccd.22874

    Article  PubMed  Google Scholar 

  13. Rolli L, Duranti L, Leuzzi G. Treatment of anaemia in the “ERAS” era: how far can we go? J Thorac Dis 2019; 11: 3692–5. https://doi.org/10.21037/jtd.2019.09.21

    Article  PubMed  PubMed Central  Google Scholar 

  14. Yoo YC, Shim JK, Kim JC, Jo YY, Lee JH, Kwak YL. Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery. Anesthesiology 2011; 115: 929–37. https://doi.org/10.1097/aln.0b013e318232004b

    Article  CAS  PubMed  Google Scholar 

  15. Elhenawy AM, Meyer SR, Bagshaw SM, MacArthur RG, Carroll LJ. Role of preoperative intravenous iron therapy to correct anemia before major surgery: a systematic review and meta-analysis. Syst Rev 2021; 10: 36. https://doi.org/10.1186/s13643-021-01579-8

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hazen YJ, Noordzij PG, Gerritse BM, et al. Preoperative anaemia and outcome after elective cardiac surgery: a Dutch national registry analysis. Br J Anaesth 2022; 128: 636–43. https://doi.org/10.1016/j.bja.2021.12.016

    Article  PubMed  Google Scholar 

  17. Al-Riyami AZ, Baskaran B, Panchatcharam SM, Al-Sabti H. Preoperative anemia is associated with increased intraoperative mortality in patients undergoing cardiac surgery. Oman Med J 2021; 36: e267. https://doi.org/10.5001/omj.2021.66

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kattou F, Montandrau O, Rekik M, et al. Critical preoperative hemoglobin value to predict anemia-related complications after cardiac surgery. J Cardiothorac Vasc Anesth 2022; 36: 1901–7. https://doi.org/10.1053/j.jvca.2022.01.013

    Article  CAS  PubMed  Google Scholar 

  19. Nguyen Q, Meng E, Berube J, Bergstrom R, Lam W. Preoperative anemia and transfusion in cardiac surgery: a single-centre retrospective study. J Cardiothorac Surg 2021; 16: 109. https://doi.org/10.1186/s13019-021-01493-z

    Article  PubMed  PubMed Central  Google Scholar 

  20. Liu HM, Tang XS, Yu H, Yu H. The efficacy of intravenous iron for treatment of anemia before cardiac surgery: an updated systematic review and meta-analysis with trial sequential analysis. J Cardiothorac Surg 2023; 18: 16. https://doi.org/10.1186/s13019-023-02119-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Elmistekawy E, Rubens F, Hudson C, et al. Preoperative anaemia is a risk factor for mortality and morbidity following aortic valve surgery. Eur J Cardiothorac Surg 2013; 44: 1051–6. https://doi.org/10.1093/ejcts/ezt143

    Article  PubMed  Google Scholar 

  22. Zindrou D, Taylor Km, Bagger JP. Preoperative haemoglobin concentration and mortality rate after coronary artery bypass surgery. Lancet 2022; 359: 1747–8. https://doi.org/10.1016/s0140-6736(02)08614-2

    Article  Google Scholar 

  23. Matsuda S, Fukui T, Shimizu J, Takao A, Takanashi S, Tomoike H. Associations between preoperative anemia and outcomes after off-pump coronary artery bypass grafting. Ann Thorac Surg 2013; 95: 854–60. https://doi.org/10.1016/j.athoracsur.2012.10.005

    Article  PubMed  Google Scholar 

  24. Cahill CM, Alhasson B, Blumberg N, et al. Preoperative anemia management program reduces blood transfusion in elective cardiac surgical patients, improving outcomes and decreasing hospital length of stay. Transfusion 2021; 61: 2629–36. https://doi.org/10.1111/trf.16564

    Article  CAS  PubMed  Google Scholar 

  25. World Health Organization. Anaemia. Available from URL: https://www.who.int/data/nutrition/nlis/info/anaemia (accessed July 2023).

  26. Sterne JA, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: I4898. https://doi.org/10.1136/bmj.l4898

    Article  Google Scholar 

  27. The Ottawa Hospital. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses; 2021. Available from URL: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed July 2023).

  28. Iorio A, Spencer FA, Falavigna M, et al. Use of GRADE for assessment of evidence about prognosis: rating confidence in estimates of event rates in broad categories of patients. BMJ 2015; 350: h870. https://doi.org/10.1136/bmj.h870

    Article  PubMed  Google Scholar 

  29. Greenland S, Robins JM. Estimation of a common effect parameter from sparse follow-up data. Biometrics 1985; 41: 55–68.

    Article  MathSciNet  CAS  PubMed  Google Scholar 

  30. Robins J, Breslow N, Greenland S. Estimators of the Mantel–Haenszel variance consistent in both sparse data and large-strata limiting models. Biometrics 1986; 42: 311–23.

    Article  MathSciNet  CAS  PubMed  Google Scholar 

  31. Balduzzi S, Rücker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health 2019; 22: 153–60. https://doi.org/10.1136/ebmental-2019-300117

    Article  PubMed  PubMed Central  Google Scholar 

  32. Higgins J, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions; 2022. Available from URL: www.training.cochrane.org/handbook (accessed July 2023).

  33. Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines: 7. Rating the quality of evidence—inconsistency. J Clin Epidemiol 2011; 64: 1294–302. https://doi.org/10.1016/j.jclinepi.2011.03.017

    Article  PubMed  Google Scholar 

  34. Carson JL, Duff A, Poses RM, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996; 348: 1055–60. https://doi.org/10.1016/s0140-6736(96)04330-9

    Article  CAS  PubMed  Google Scholar 

  35. Manosroi W, Atthakomol P, Isaradech N, Phinyo P, Vaseenon T. Preoperative correction of low hemoglobin levels can reduce 1-year all-cause mortality in osteoporotic hip fracture patients: a retrospective observational study. Clin Interv Aging 2022; 17: 165–73. https://doi.org/10.2147/cia.s354519

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Fisher Z, Tipton E. robumeta: an R-package for robust variance estimation in meta-analysis. Available from URL: https://cran.r-project.org/web/packages/robumeta/vignettes/robumetaVignette.pdf (accessed July 2023).

  37. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14: 135. https://doi.org/10.1186/1471-2288-14-135

    Article  PubMed  PubMed Central  Google Scholar 

  38. Bell ML, Grunwald GK, Baltz JH, et al. Does preoperative hemoglobin independently predict short-term outcomes after coronary artery bypass graft surgery? Ann Thorac Surg 2008; 86: 1415–23. https://doi.org/10.1016/j.athoracsur.2008.07.088

    Article  PubMed  Google Scholar 

  39. Blaudszun G, Munting KE, Butchart A, Gerrard C, Klein AA. The association between borderline pre-operative anaemia in women and outcomes after cardiac surgery: a cohort study. Anaesthesia 2018; 73: 572–8. https://doi.org/10.1111/anae.14185

    Article  CAS  PubMed  Google Scholar 

  40. Carrascal Y, Maroto L, Rey J, et al. Impact of preoperative anemia on cardiac surgery in octogenarians. Interactive Cardiovasc Thorac Surg 2010; 10: 249–55. https://doi.org/10.1510/icvts.2009.220160

    Article  Google Scholar 

  41. Cladellas M, Bruguera J, Comín J, et al. Is pre-operative anaemia a risk marker for in-hospital mortality and morbidity after valve replacement? Eur Heart J 2006; 27: 1093–9. https://doi.org/10.1093/eurheartj/ehi830

    Article  PubMed  Google Scholar 

  42. De Santo L, Romano G, Della Corte A, et al. Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury. J Thorac Cardiovasc Surg 2009; 138: 965–70. https://doi.org/10.1016/j.jtcvs.2009.05.013

    Article  PubMed  Google Scholar 

  43. Deepak B, Balaji A, Pramod A, et al. The prevalence and impact of preoperative anemia in patients undergoing cardiac surgery for rheumatic heart disease. J Cardiothorac Vasc Anesth 2016; 30: 896–900. https://doi.org/10.1053/j.jvca.2015.10.012

    Article  PubMed  Google Scholar 

  44. Ewila H, Eltigani A, Abdelaziz A, Badr A, Kindawi A, Elmahrouk A. Preoperative hemoglobin concentration as an independent predictor for outcome after coronary artery bypass grafting. J Egypt Soc Cardio-Thorac Surg 2016; 24: 265–9. https://doi.org/10.1016/j.jescts.2016.11.004

    Article  Google Scholar 

  45. Hung M, Besser M, Sharples LD, Nair SK, Klein AA. The prevalence and association with transfusion, intensive care unit stay and mortality of pre-operative anaemia in a cohort of cardiac surgery patients. Anaesthesia 2011; 66: 812–8. https://doi.org/10.1111/j.1365-2044.2011.06819.x

    Article  CAS  PubMed  Google Scholar 

  46. Jabagi H, Boodhwani M, Tran DT, Sun L, Wells G, Rubens FD. The effect of preoperative anemia on patients undergoing cardiac surgery: a propensity-matched analysis. Sem Thorac Cardiovasc Surg 2019; 31: 157–63. https://doi.org/10.1053/j.semtcvs.2018.09.015

    Article  Google Scholar 

  47. Karkouti K, Wijeysundera DN, Beattie WS. Risk associated with preoperative anemia in cardiac surgery. Circulation 2008; 117: 478–84. https://doi.org/10.1161/circulationaha.107.718353

    Article  PubMed  Google Scholar 

  48. Karkouti K, Wijeysundera DN, Yau Terrence M, et al. Influence of erythrocyte transfusion on the risk of acute kidney injury after cardiac surgery differs in anemic and nonanemic patients. Anesthesiology 2011; 115: 523–30. https://doi.org/10.1097/aln.0b013e318229a7e8

    Article  CAS  PubMed  Google Scholar 

  49. Kim CJ, Connell H, McGeorge AD, Hu R. Prevalence of preoperative anaemia in patients having first-time cardiac surgery and its impact on clinical outcome. A retrospective observational study. Perfusion 2015; 30: 277–83. https://doi.org/10.1177/0267659114542457

    Article  CAS  PubMed  Google Scholar 

  50. Klein AA, Collier TJ, Brar MS, et al. The incidence and importance of anaemia in patients undergoing cardiac surgery in the UK—the first Association of Cardiothoracic Anaesthetists national audit. Anaesthesia 2016; 71: 627–35. https://doi.org/10.1111/anae.13423

    Article  CAS  PubMed  Google Scholar 

  51. Kotal R, Yunus M, Karim HM, et al. Influence of packed red cell transfusion on risk of acute kidney injury after cardiopulmonary bypass in anemic and non-anemic patients. Anaesth Pain Intensive Care 2016; 20: S42–7.

    CAS  Google Scholar 

  52. Kumar S, Khurana NK, Awan I, et al. The effect of preoperative hematocrit levels on early outcomes after coronary artery bypass graft. Cureus 2021; 13: e12733. https://doi.org/10.7759/cureus.12733

    Article  PubMed  PubMed Central  Google Scholar 

  53. Miceli A, Romeo F, Glauber M, de Siena PM, Caputo M, Angelini GD. Preoperative anemia increases mortality and postoperative morbidity after cardiac surgery. J Cardiothorac Surg 2014; 9: 137. https://doi.org/10.1186/1749-8090-9-137

    Article  PubMed  PubMed Central  Google Scholar 

  54. Muñoz M, Ariza D, Gómez‐Ramírez S, Hernández P, García‐Erce JA, Leal‐Noval SR. Preoperative anemia in elective cardiac surgery: prevalence, risk factors, and influence on postoperative outcome. Transfus Altern Transfus Med 2010; 11: 47–56. https://doi.org/10.1111/j.1778-428X.2010.01126.x

    Article  Google Scholar 

  55. Padmanabhan H, Aktuerk D, Brookes MJ, et al. Anemia in cardiac surgery: next target for mortality and morbidity improvement? Asian Cardiovasc Thorac Ann 2016; 24: 12–7. https://doi.org/10.1177/0218492315618032

    Article  PubMed  Google Scholar 

  56. Ripoll JG, Smith MM, Hanson AC, et al. Sex-specific associations between preoperative anemia and postoperative clinical outcomes in patients undergoing cardiac surgery. Anesth Analg 2021; 132: 1101–11. https://doi.org/10.1213/ane.0000000000005392

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Sadeghi A, Ferasatkish R, Heydarpour A, et al. Prevalence of anemia in patients undergoing cardiac surgery and need for transfusion during surgery regarding hemoglobin levels in Rajaie Heart Center. Iran Heart J 2020; 21: 94–102.

    Google Scholar 

  58. Sallam A, Hassan E. Effect of pre-operative hemoglobin level on early outcomes in patients undergoing urgent coronary artery bypass grafting. J Egypt Soc Cardio-Thorac Surg 2018; 26: 252–6. https://doi.org/10.1016/j.jescts.2018.11.006

    Article  Google Scholar 

  59. Shavit L, Hitti S, Silberman S, et al. Preoperative hemoglobin and outcomes in patients with CKD undergoing cardiac surgery. Clin J Am Soc Nephrol 2014; 9: 1536–44. https://doi.org/10.2215/cjn.00110114

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Shirzad M, Karimi A, Dowlatshahi S, et al. Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery. Open Med 2010; 5: 308–14. https://doi.org/10.2478/s11536-009-0094-6

    Article  Google Scholar 

  61. Tauriainen T, Koski-Vähälä J, Kinnunen E-M, Biancari F. The effect of preoperative anemia on the outcome after coronary surgery. World J Surg 2017; 41: 1910–8. https://doi.org/10.1007/s00268-017-3911-0

    Article  PubMed  Google Scholar 

  62. van Straten AH, Külcü K, Özdemir HI, Elenbaas TW, Hamad MA. Preoperative hemoglobin level as a predictor of mortality after aortic valve replacement. J Cardiothorac Vasc Anesth 2013; 27: 716–22. https://doi.org/10.1053/j.jvca.2012.12.021

    Article  CAS  PubMed  Google Scholar 

  63. van Straten AH, Soliman Hamad MA, van Zundert AJ, Martens EJ, Schönberger JP, de Wolf AM. Preoperative hemoglobin level as a predictor of survival after coronary artery bypass grafting: a comparison with the matched general population. Circulation 2009; 120: 118–25. https://doi.org/10.1161/circulationaha.109.854216

    Article  PubMed  Google Scholar 

  64. von Heymann C, Kaufner L, Sander M, et al. Does the severity of preoperative anemia or blood transfusion have a stronger impact on long-term survival after cardiac surgery? J Thorac Cardiovasc Surg 2016; 152: 1412–20. https://doi.org/10.1016/j.jtcvs.2016.06.010

    Article  Google Scholar 

  65. Zhang L, Hiebert B, Zarychanski R, Arora RC. Preoperative anemia does not increase the risks of early surgical revascularization after myocardial infarction. Ann Thorac Surg 2013; 95: 542–7. https://doi.org/10.1016/j.athoracsur.2012.07.011

    Article  PubMed  Google Scholar 

  66. Jafari S, Azita T, Abbas S, Hamid A, Arash J. Effects of iron sucrose and erythropoietin on transfusion requirements in patients with preoperative iron deficiency anemia undergoing on-pump coronary artery bypass graft. J Tehran Heart Cent 2022; 17: 7–14. https://doi.org/10.18502/jthc.v17i1.9319

    Article  PubMed  PubMed Central  Google Scholar 

  67. Karkouti K, Wijeysundera DN, Yau TM, et al. Advance targeted transfusion in anemic cardiac surgical patients for kidney protection: an unblinded randomized pilot clinical trial. Anesthesiology 2012; 116: 613–21. https://doi.org/10.1097/aln.0b013e3182475e39

    Article  CAS  PubMed  Google Scholar 

  68. Kong R, Hutchinson N, Hill A, et al. Randomised open-label trial comparing intravenous iron and an erythropoiesis-stimulating agent versus oral iron to treat preoperative anaemia in cardiac surgery (INITIATE trial). Br J Anaesth 2022; 128: 796–805. https://doi.org/10.1016/j.bja.2022.01.034

    Article  CAS  PubMed  Google Scholar 

  69. Padmanabhan H, Siau K, Curtis J, et al. Preoperative anemia and outcomes in cardiovascular surgery: systematic review and meta-analysis. Ann Thorac Surg 2019; 108: 1840–8. https://doi.org/10.1016/j.athoracsur.2019.04.108

    Article  PubMed  Google Scholar 

  70. Shokri H, Ali I. Intravenous iron supplementation treats anemia and reduces blood transfusion requirements in patients undergoing coronary artery bypass grafting—a prospective randomized trial. Ann Card Anaesth 2022; 25: 141–7. https://doi.org/10.4103/aca.aca_209_20

    Article  PubMed  PubMed Central  Google Scholar 

  71. Spahn DR, Schoenrath F, Spahn GH, et al. Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial. Lancet 2019; 393: 2201–12. https://doi.org/10.1016/s0140-6736(18)32555-8

    Article  PubMed  Google Scholar 

  72. Cladellas M, Farré N, Comín-Colet J, et al. Effects of preoperative intravenous erythropoietin plus iron on outcome in anemic patients after cardiac valve replacement. Am J Cardiol 2012; 110: 1021–6. https://doi.org/10.1016/j.amjcard.2012.05.036

    Article  CAS  PubMed  Google Scholar 

  73. Evans CR, Jones R, Phillips G, Greene G, Phillips M, Morris-Clarke R. Observational study of pre-operative intravenous iron given to anaemic patients before elective cardiac surgery. Anaesthesia 2021; 76: 639–46. https://doi.org/10.1111/anae.15396

    Article  CAS  PubMed  Google Scholar 

  74. Klein AA, Chau M, Yeates JA, et al. Preoperative intravenous iron before cardiac surgery: a prospective multicentre feasibility study. Br J Anaesth 2020; 124: 243–50. https://doi.org/10.1016/j.bja.2019.11.023

    Article  CAS  PubMed  Google Scholar 

  75. Quarterman C, Shaw M, Hughes S, Wallace V, Agarwal S. Anaemia in cardiac surgery—a retrospective review of a centre's experience with a pre-operative intravenous iron clinic. Anaesthesia 2021; 76: 629–38. https://doi.org/10.1111/anae.15271

    Article  CAS  PubMed  Google Scholar 

  76. Ranucci M, Pavesi M, Pistuddi V, Baryshnikova E. Preoperative anemia correction in cardiac surgery: a propensity-matched study. J Cardiothorac Vasc Anesth 2021; 35: 874–81. https://doi.org/10.1053/j.jvca.2020.07.015

    Article  CAS  PubMed  Google Scholar 

  77. Duarte GC, Catanoce AP, Zabeu JL, et al. Association of preoperative anemia and increased risk of blood transfusion and length of hospital stay in adults undergoing hip and knee arthroplasty: an observational study in a single tertiary center. Health Sci Rep 2021; 4: e448. https://doi.org/10.1002/hsr2.448

    Article  PubMed  PubMed Central  Google Scholar 

  78. Rosencher N, Kerkkamp HE, Macheras G, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 2003; 43: 459–69. https://doi.org/10.1046/j.1537-2995.2003.00348.x

    Article  PubMed  Google Scholar 

  79. Koch CG, Li L, Duncan AI, et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006; 34: 1608–16. https://doi.org/10.1097/01.ccm.0000217920.48559.d8

    Article  PubMed  Google Scholar 

  80. Sanaiha Y, Hadaya J, Verma A, et al. Morbidity and mortality associated with blood transfusions in elective adult cardiac surgery. J Cardiothorac Vasc Anesth 2022; https://doi.org/10.1053/j.jvca.2022.11.012

    Article  PubMed  Google Scholar 

Download references

Author contributions

Ryan Ruiyang Ling and Kollengode Ramanathan contributed to study design. Michele Petrova Xin Ling Lau, Christopher Jer Wei Low, Ryan Ruiyang Ling, Nigel Sheng Hui Liu, and Kollengode Ramanathan contributed to search strategy and screening of articles. Michele Petrova Xin Ling Lau, Christopher Jer Wei Low, Ryan Ruiyang Ling, Nigel Sheng Hui Liu, and Kollengode Ramanathan contributed to risk of bias assessment. Michele Petrova Xin Ling Lau, Christopher Jer Wei Low, Ryan Ruiyang Ling, Nigel Sheng Hui Liu, and Kollengode Ramanathan contributed to data collection. Christopher Jer Wei Low, Ryan Ruiyang Ling, Chuen Seng Tan, and Kollengode Ramanathan contributed to data analysis and interpretation. Christopher Jer Wei Low, Michele Petrova Xin Ling Lau, and Nigel Sheng Hui Liu contributed to tables and figures. Michele Petrova Xin Ling Lau, Christopher Jer Wei Low, Ryan Ruiyang Ling, and Nigel Sheng Hui Liu contributed to drafting of manuscript. All authors provided critical conceptual input, interpreted the data analysis, and revised the manuscript for intellectually important content. Christopher Jer Wei Low, Michele Petrova Xin Ling Lau, Ryan Ruiyang Ling, Nigel Sheng Hui Liu, and Kollengode Ramanathan have accessed and verified the data. Christopher Jer Wei Low, Michele Petrova Xin Ling Lau, and Kollengode Ramanathan were responsible for the decision to submit the manuscript.

Acknowledgements

The authors would like to acknowledge Suei Nee Wong from the Medical Library, National University of Singapore, for her assistance with the search strategy. There was no funding for this study.

In memoriam

Professor C. S. Tan sadly died prior to the publication of this study. The remaining coauthors would like to pay tribute to him. He was an excellent statistician and colleague, and we are deeply grateful for his wise counsel over many years.

Disclosures

The authors declare no competing interests.

Funding statement

There was no funding source for this study.

Data availability

All data generated or analyzed during this study are included in the published studies and their supplementary information files.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Deputy Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

Author information

Author notes

  1. Michele P. X. L. Lau and Christopher J. W. Low have contributed equally to the manuscript.

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore

    Michele P. X. L. Lau MBBS, Christopher J. W. Low MBBS, Ryan Ruiyang Ling MBBS, Nigel S. H. Liu MBBS, Chuen Seng Tan PhD, Lian Kah Ti FRCA, Theo Kofidis MD, PhD, Graeme MacLaren MBBS, MSc & Kollengode Ramanathan MD

  2. Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore

    Chuen Seng Tan PhD

  3. Department of Anaesthesia, National University Hospital, National University Health System, Singapore, Singapore

    Lian Kah Ti FRCA

  4. Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre, National University Hospital, National University Health System, Singapore, Singapore

    Theo Kofidis MD, PhD

  5. Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, National University Health System, Singapore, Singapore

    Graeme MacLaren MBBS, MSc & Kollengode Ramanathan MD

  6. Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Kollengode Ramanathan MD

Authors
  1. Michele P. X. L. Lau MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher J. W. Low MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryan Ruiyang Ling MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nigel S. H. Liu MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chuen Seng Tan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lian Kah Ti FRCA
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Theo Kofidis MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Graeme MacLaren MBBS, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kollengode Ramanathan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kollengode Ramanathan MD.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 1688 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lau, M.P.X.L., Low, C.J.W., Ling, R.R. et al. Preoperative anemia and anemia treatment in cardiac surgery: a systematic review and meta-analysis. Can J Anesth/J Can Anesth 71, 127–142 (2024). https://doi.org/10.1007/s12630-023-02620-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12630-023-02620-1

Keywords

Search

Navigation