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Anemia in Cardiac Surgery - Can Something Bad Get Worse?
Leandro Batisti de Faria1, Omar Vilca Mejia2,3, Leonardo Augusto Miana1,2
1Hospital do Coração (HCor), São Paulo, São Paulo, Brazil.
Insights
Anemia is a risk factor for cardiac surgery patients, but blood transfusions may pose a greater risk for mortality and morbidity following coronary artery bypass grafting (CABG).
Area of Science:
- Cardiovascular Surgery
- Hematology
- Clinical Outcomes Research
Background:
- Anemia and blood transfusions are recognized risk factors for adverse outcomes in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
- Understanding the independent and combined effects of anemia and blood transfusion is crucial for optimizing patient care during and after coronary artery bypass grafting (CABG).
Purpose of the Study:
- To investigate the association between blood transfusion and morbidity/mortality in patients undergoing CABG with CPB.
- To compare outcomes among patients with and without anemia, and with and without blood transfusion.
Main Methods:
- Retrospective analysis of the State of São Paulo Registry of Cardiovascular Surgery (November 2013 - August 2014).
- Inclusion criteria: adult patients undergoing CABG with CPB. Exclusion criteria: patients < 18 years old.
- Patients categorized into four groups: no anemia, anemia without transfusion, no anemia with transfusion, and anemia with transfusion.
Main Results:
- Out of 1,490 patients, 42.9% were anemic and 29.5% received transfusions.
- Anemia alone (Group II) showed no significant difference in composite morbidity compared to no anemia without transfusion (Group I).
- Patients receiving blood transfusions, regardless of anemia status (Groups III and IV), exhibited significantly higher composite morbidity compared to those without transfusion.
Conclusions:
- Anemia is a significant factor in CABG outcomes.
- Blood transfusion, even in non-anemic patients, appears to be an independent risk factor for increased morbidity and mortality after CABG.
- Clinical strategies should aim to minimize blood transfusions in CABG patients.
Introduction:
Anemia and blood transfusion are risk factors for morbidity/mortality in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The objective of this study is to analyze the association of blood transfusion with morbidity/ mortality in patients undergoing coronary artery bypass grafting (CABG) under CPB in the state of São Paulo, Brazil.
Methods:
This is a retrospective analysis using the State of São Paulo Registry of Cardiovascular Surgery from November 2013 to August 2014. Blood transfusion was only considered during surgery or within six hours after surgery. Anemia was defined as hematocrit ≤ 37.5%. Patients < 18 years old were excluded. The sample was divided in four groups - Group I (851, no anemia), Group II (200, anemia without blood transfusion), Group III (181, no anemia and transfusion), and Group IV (258, anemia and transfusion).
Results:
A total of 1,490 patients were included; 639 (42.9%) were anemic and 439 (29.5%) underwent blood transfusion. Group II showed lower composite morbidity (odds ratio [OR] -0.05; confidence interval [CI] -0.27-0.17; P=0.81) than Group III (OR 0.41; CI 0.23-0.59; P=0.018) or Group IV (OR 0.54; CI 0.31- 0.77; P=0.016). Group III was at greater risk of mortality (OR 0.73; CI 0.43-1.03; P=0.02) than Group II, which was exposed only to anemia (OR -0.13; CI -0.55-0.29; P=0.75), or Group IV (OR 0.29; CI -0.13-0.71; P=0.539).
Conclusion:
Anemia in patients undergoing CABG with CPB is bad, but blood transfusion can be worse, increasing at least 50% the risk for mortality and/or morbidity.
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