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Pre-operative anaemia and myocardial injury after noncardiac surgery: A retrospective study
Ji-Hye Kwon1, Jungchan Park, Seung-Hwa Lee
1From the Department of Anesthesiology and Pain Medicine (J-HK, JP, JHL, JJM, ARO, WS), Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute (S-HL, CWH, J-hC, S-CL, H-CG), Center for Health Promotion (KY), Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (J-hC), Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center (KK, JA), Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea (KK).
Background:
Pre-operative anaemia is associated with adverse outcomes of noncardiac surgery, but its association with myocardial injury after noncardiac surgery (MINS) has not been fully investigated.
Objective:
The association between pre-operative anaemia and MINS.
Design:
A single-centre retrospective cohort study.
Setting:
Tertiary care referral centre.
Patients:
Patients with measured cardiac troponin (cTn) I levels after noncardiac surgery.
Interventions:
Patients were separated according to pre-operative anaemia (haemoglobin <13 g dl-1 in men and <12 g dl-1 in women). Anaemia was further stratified into mild and moderate-to-severe at a haemoglobin level threshold of 11 g dl-1.
Main Outcome Measures:
The primary outcome was MINS, defined as a peak cTn I level more than 99th percentile of the upper reference limit within 30 postoperative days.
Results:
Data from a total of 35 170 patients were collected, including 22 062 (62.7%) patients in the normal group and 13 108 (37.3%) in the anaemia group. After propensity score matching, 11919 sets of patients were generated, and the incidence of MINS was significantly associated with anaemia [14.5 vs. 21.0%, odds ratio (OR) 1.57, 95% confidence interval (CI) 1.47 to 1.68, P < 0.001]. For the entire population, multivariable analysis showed a graded association between anaemia severity and MINS (OR 1.32, 95% CI 1.22 to 1.43, P < 0.001 for mild anaemia and OR 1.80, 95% CI 1.66 to 1.94, P < 0.001 for moderate-to-severe anaemia compared with the normal group) and a significantly higher incidence of MINS for moderate-to-severe anaemia than mild anaemia (18.6 vs. 28.6%, OR 1.37, 95% CI 1.25 to 1.50, P < 0.001). The estimated threshold for pre-operative haemoglobin associated with MINS was 12.2 g dl-1, with an area under the curve of 0.622.
Conclusions:
Pre-operative anaemia was independently associated with MINS, suggesting that MINS may be related to the association between anaemia and postoperative mortality.
Trial Registration:
SMC 2019-08-048.
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