Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery
- 83 Downloads
Anemia is an indisputable finding in patients scheduled for coronary artery bypass graft (CABG) that can occur any time preoperatively. In presence of severe coronary artery disease, anemia can dramatically affect surgical outcomes. Therefore, we conducted this study to determine the effect of low preoperative hemoglobin (Hgb) on postoperative outcome in patients who underwent coronary artery bypass graft (CABG). In all, 4432 patients who had undergone isolated CABG at Tehran Heart Center over the 2-year period from March 2006 to February 2008 were studied. All medical records of the aforementioned patients were derived from our hospital surgery data bank. After adjustment for confounders, the association of different preoperative levels of Hgb with risk of cardiac, pulmonary, infectious, and ischemic complications, and also with prolonged ventilation and resource utilization, were assessed in a multivariable model. After adjustment for confounders that may affect mortality and morbidities, we found that cardiac, infectious, ischemic, and pulmonary complications, as well as postoperative mortality, were significantly higher in anemic patients compared to those with normal Hgb levels. In addition, total ventilation time, total intensive care unit hour stay (ICU), hospital length of stay (HLOS), and postsurgery length of stay (PLOS) were significantly longer in anemic patients. We concluded that isolated CABG patients with preoperative anemia have significantly higher mortality and morbidity, and use more health care resources. Preoperative anemia is an independent variable for increased resource utilization, morbidity, and mortality.
KeywordsAnemia Hemoglobin Coronary artery bypass grafting Postoperative complication Mortality
Unable to display preview. Download preview PDF.
- Fang WC, Helm RE, Krieger KH, Rosengart TK, DuBois WJ, Sason C, Lesser ML, Isom OW, Gold JP. Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation. 1997, 96 II-194–II-199Google Scholar
- STS Adult Cardiac Database. Definition of terms. Version 2.41. Society of Thoracic Surgeons. Available at www. Sts. org / file / CoreDef 241 Book. PdfGoogle Scholar
- Spiess BD, Ley C, Body SC, Siegel LC, Stover EP, Maddi R, D’Ambra M, Jain U, Liu F, Herskowitz A, Mangano DT, Levin J; the Institutions of the Multicenter Study of Perioperative Ischemia (McSPI) Research Group. Hematocrit value on intensive care unit entry influences the frequency of Q-wave myocardial infarction after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1998, 116, 460–467CrossRefPubMedGoogle Scholar
- Van Straten AH, Soliman Hamad MA, van Zundert AJ, Martens EJ, Schönberger JP, de Wolf AM. Preoperative Hgb Level as a Predictor of Survival After Coronary Artery Bypass Grafting. A Comparison With the Matched General Population. Circulation; 2009; [Epub ahead of print]Google Scholar
- Weber WP, Zwahlen M, Reck S, et al. The association of preoperative anemia and perioperative allogeneic blood transfusion with the risk of surgical site infection. Transfusion 2009; [Epub ahead of print]Google Scholar
- Anker SD, Voors A, Okonko D, Clark AL, James MK, von Haehling S, Kjekshus J, Ponikowski P, Dickstein K; for the OPTIMAAL investigators. Prevalence, incidence, and prognostic value of anaemia in patients after an acute myocardial infarction: data from the OPTIMAAL trial. Eur Heart J 2009; doi:10.1093/eurheartj/ehp116Google Scholar
- Milman N, Pedersen AN. Blood haemoglobin concentrations are higher in smokers and heavy alcohol consumers than in non-smokers and abstainers-should we adjust the reference range? Ann Hematol 2008; [Epub ahead of print]Google Scholar