1. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery
- Author
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Jack Levin, Dennis T. Mangano, Rita Moser, Iulia Cristina Tudor, Stephanie A. Snyder-Ramos, Patrick Moehnle, Alexander Kulier, and Gudrun Rumpold-Seitlinger
- Subjects
Male ,Blood transfusion ,medicine.medical_treatment ,Comorbidity ,Severity of Illness Index ,law.invention ,Hemoglobins ,Plasma ,Postoperative Complications ,law ,Risk Factors ,Multicenter Studies as Topic ,Hospital Mortality ,Prospective Studies ,Coronary Artery Bypass ,Prospective cohort study ,Hypoxia, Brain ,Intraoperative Complications ,Cardiopulmonary Bypass ,Anemia ,Acute Kidney Injury ,Middle Aged ,Treatment Outcome ,Cardiology ,Female ,Disease Susceptibility ,Cardiology and Cardiovascular Medicine ,Erythrocyte Transfusion ,medicine.medical_specialty ,Heart Diseases ,Iron ,Platelet Transfusion ,Revascularization ,Infections ,Sex Factors ,Physiology (medical) ,Internal medicine ,medicine ,Cardiopulmonary bypass ,Humans ,Blood Transfusion ,Aged ,Intraoperative Care ,business.industry ,Transfusion Reaction ,EuroSCORE ,Perioperative ,medicine.disease ,Surgery ,Platelet transfusion ,business - Abstract
Background— The risk of preoperative anemia in patients undergoing heart surgery has not been described precisely. Specifically, the impact of low hemoglobin per se or combined with other risk factors on postoperative outcome is unknown. Thus, we determined the effects of low preoperative hemoglobin and comorbidities on postoperative adverse outcomes in patients with coronary artery bypass graft in a large comprehensive multicenter study. Methods and Results— The Multicenter Study of Perioperative Ischemia investigated 5065 patients with coronary artery bypass graft at 70 institutions worldwide, collecting ≈7500 data points per patient. In 4804 patients who received no preoperative transfusions, we determined the association between lowest preoperative hemoglobin levels and in-hospital cardiac and noncardiac morbidity and mortality and the impact of concomitant risk factors, assessed by EuroSCORE, on this effect. In patients with EuroSCORE cerebral; P Conclusions— Anemic patients undergoing cardiac surgery have an increased risk of postoperative adverse events. Importantly, the extent of preexisting comorbidities substantially affects perioperative anemia tolerance. Therefore, preoperative risk assessment and subsequent therapeutic strategies, such as blood transfusion, should take into account both the individual level of preoperative hemoglobin and the extent of concomitant risk factors.
- Published
- 2007