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Postoperative anemia in cardiac surgery patients: a narrative review

Anémie postopératoire chez la patientèle de chirurgie cardiaque : un compte rendu narratif

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

Abstract

Purpose

Anemia reduces the blood’s ability to carry and deliver oxygen. Following cardiac surgery, anemia is very common and affects up to 90% of patients. Nevertheless, there is a paucity of data examining the prognostic value of postoperative anemia. In this narrative review, we present findings from the relevant literature on postoperative anemia in cardiac surgery patients, focusing on the incidence, risk factors, and prognostic value of postoperative anemia. We also explore the potential utility of postoperative anemia as a therapeutic target to improve clinical outcomes.

Source

We conducted a targeted search of MEDLINE, Embase, and the Cochrane Database of Systematic Reviews up to September 2022, using a combination of search terms including postoperative (post-operative), perioperative (peri-operative), anemia (anaemia), and cardiac surgery.

Principal findings

The reported incidence of postoperative anemia varied from 29% to 94% across the studies, likely because of variations in patient inclusion criteria and classification of postoperative anemia. Nonetheless, the weight of the evidence suggests that postoperative anemia is common and is an independent risk factor for adverse postoperative outcomes such as acute kidney injury, stroke, mortality, and functional outcomes.

Conclusions

In cardiac surgery patients, postoperative anemia is a common and prognostically important risk factor for postoperative morbidity and mortality. Nevertheless, there is a lack of data on whether active management of postoperative anemia is feasible or effective in improving patient outcomes.

Résumé

Objectif

L’anémie réduit la capacité du sang à transporter et à fournir de l’oxygène. Suite à une chirurgie cardiaque, l’anémie est très fréquente et touche jusqu’à 90 % des patient·es. Néanmoins, il existe peu de données examinant la valeur pronostique de l’anémie postopératoire. Dans ce compte rendu narratif, nous présentons les résultats de la littérature pertinente sur l’anémie postopératoire chez les patient·es ayant bénéficié d’une chirurgie cardiaque, en mettant l’accent sur l’incidence, les facteurs de risque et la valeur pronostique de l’anémie postopératoire chez les personnes ayant bénéficié d’une chirurgie cardiaque. Nous explorons également l’utilité potentielle de l’anémie postopératoire en tant que cible thérapeutique pour améliorer les devenirs cliniques.

Sources

Nous avons réalisé une recherche ciblée dans MEDLINE, Embase et la base de données des revues systématiques Cochrane jusqu’en septembre 2022, en utilisant une combinaison de termes de recherche, notamment postopératoire (postoperative/post-operative), périopératoire (perioperative/peri-operative), anémie (anemia/anaemia) et chirurgie cardiaque (cardiac surgery).

Constatations principales

L’incidence rapportée de l’anémie postopératoire variait de 29 % à 94 % d’une étude à l’autre, probablement en raison des variations dans les critères d’inclusion des patient·es et la classification de l’anémie postopératoire. Néanmoins, le poids de la preuve suggère que l’anémie postopératoire est courante et constitue un facteur de risque indépendant pour les devenirs postopératoires indésirables tels que l’insuffisance rénale aiguë, les accidents vasculaires cérébraux, la mortalité et les devenirs fonctionnels.

Conclusion

Chez la patientèle en chirurgie cardiaque, l’anémie postopératoire est un facteur de risque commun et pronostiquement important de morbidité et de mortalité postopératoires. Néanmoins, il y a un manque de données sur la faisabilité ou l’efficacité de la prise en charge active de l’anémie postopératoire pour améliorer les devenirs des patient·es.

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Author contributions

Michelle M. Li, Sarah Miles, Jeannie Callum, Yulia Lin, Keyvan Karkouti, and Justyna Bartoszko contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article.

Disclosures

Justyna Bartoszko is in part supported by a merit award from the Department of Anesthesiology and Pain Medicine, University of Toronto and has received honoraria from Octapharma and research support from the Canadian Blood Services and Grifols. Keyvan Karkouti is in part supported by a merit award from the Department of Anesthesiology and Pain Medicine, University of Toronto and has received research support, honoraria, or consultancy for speaking engagements from Octapharma and Instrumentation Laboratory. Jeannie Callum has received research support from Canadian Blood Services and Octapharma. Yulia Lin has received research support from Canadian Blood Services and Octapharma and is a consultant with Choosing Wisely Canada.

Funding

This work was not funded.

Editorial responsibility

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

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Authors and Affiliations

  1. Institute of Medical Science, University of Toronto, Toronto, ON, Canada

    Michelle M. Li BMSc, Keyvan Karkouti MD, MSc, FRCPC & Justyna Bartoszko MD, MSc, FRCPC

  2. Department of Anesthesia and Pain Management, Sinai Health System, Women’s College Hospital, University Health Network, Toronto, ON, Canada

    Michelle M. Li BMSc, Sarah Miles PhD, Keyvan Karkouti MD, MSc, FRCPC & Justyna Bartoszko MD, MSc, FRCPC

  3. University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada

    Jeannie Callum MD, FRCPC, Yulia Lin MD, FRCPC, Keyvan Karkouti MD, MSc, FRCPC & Justyna Bartoszko MD, MSc, FRCPC

  4. Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen’s University, Kingston, ON, Canada

    Jeannie Callum MD, FRCPC

  5. Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Yulia Lin MD, FRCPC

  6. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    Yulia Lin MD, FRCPC

  7. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada

    Keyvan Karkouti MD, MSc, FRCPC & Justyna Bartoszko MD, MSc, FRCPC

  8. Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada

    Keyvan Karkouti MD, MSc, FRCPC & Justyna Bartoszko MD, MSc, FRCPC

  9. Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    Keyvan Karkouti MD, MSc, FRCPC & Justyna Bartoszko MD, MSc, FRCPC

  10. Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada

    Keyvan Karkouti MD, MSc, FRCPC & Justyna Bartoszko MD, MSc, FRCPC

Authors
  1. Michelle M. Li BMSc
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  2. Sarah Miles PhD
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  3. Jeannie Callum MD, FRCPC
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  4. Yulia Lin MD, FRCPC
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  5. Keyvan Karkouti MD, MSc, FRCPC
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  6. Justyna Bartoszko MD, MSc, FRCPC
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Corresponding author

Correspondence to Justyna Bartoszko MD, MSc, FRCPC.

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This article is accompanied by an Editorial. Please see Can J Anesth 2024; https://doi.org/10.1007/s12630-023-02649-2.

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Li, M.M., Miles, S., Callum, J. et al. Postoperative anemia in cardiac surgery patients: a narrative review. Can J Anesth/J Can Anesth 71, 408–421 (2024). https://doi.org/10.1007/s12630-023-02650-9

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  • DOI: https://doi.org/10.1007/s12630-023-02650-9

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