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The Effect of Preoperative Hematocrit Levels on Early Outcomes After Coronary Artery Bypass Graft
Suresh Kumar1, Naresh Kumar Khurana2, Inayatullah Awan3
1Internal Medicine, Bolan University of Medical and Health Sciences, Quetta, PAK.
Insights
Patients undergoing coronary artery bypass graft (CABG) surgery with lower preoperative hematocrit (hct) levels experience increased blood loss, transfusion needs, and longer intensive care unit (ICU) stays. Routine preoperative hct checks are recommended.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Anesthesiology
Background:
- Coronary artery bypass graft (CABG) surgery is a critical intervention for severe coronary artery disease.
- Preoperative patient factors significantly influence surgical outcomes and recovery.
- Hematocrit (hct) levels, a measure of red blood cell concentration, may impact perioperative complications.
Purpose of the Study:
- To investigate the association between preoperative hematocrit levels and postoperative outcomes in patients undergoing CABG.
- To determine if lower-than-normal hematocrit levels correlate with increased complications after CABG surgery.
Main Methods:
- A longitudinal study involving 82 participants scheduled for CABG surgery from April to December 2019.
- Participants were stratified into two groups based on preoperative hematocrit: lower levels (Group 1) and normal levels (Group 2).
- Postoperative outcomes, including blood loss, transfusion requirements, and ICU length of stay, were compared between the two groups.
Main Results:
- Patients with lower preoperative hematocrit (Group 1) exhibited significantly greater blood loss via drainage compared to those with normal hematocrit (Group 2) (680.1 ± 301 mL vs. 500.7 ± 412 mL; p=0.02).
- Group 1 required more blood and blood product transfusions (3.2 ± 1.8 units vs. 1.8 ± 0.9 units; p<0.0001).
- Participants in Group 1 also experienced longer intensive care unit (ICU) stays (5.2 ± 3.1 days vs. 3.4 ± 2.5 days; p=0.003).
Conclusions:
- Lower preoperative hematocrit levels in CABG patients are associated with increased postoperative complications.
- These complications include excessive blood loss, a higher need for transfusions, and prolonged ICU stays.
- Routine preoperative assessment of hematocrit levels is advisable for CABG candidates to mitigate potential adverse events.
Abstract:
Introduction Coronary artery bypass graft (CABG) is the most potent of surgical procedures; in this procedure, the narrowing of the coronary artery due to atherosclerotic plaque is bypassed by forming an alternate route for blood flow to the heart. There are various risk factors associated with the procedure. The aim of this study was to observe if postoperative outcomes are affected by preoperative hematocrit (hct) levels in patients. Methods This longitudinal study was conducted from April 2019 to December 2019. Eighty-two (82) participants who were to undergo CABG surgery were divided into two groups based on their preoperative hct levels. Group 1 had 42 participants with lower levels of hct (less than 35.5% for women and 38.3% for men), whereas group 2 consisted of 40 participants with normal hct levels (greater than 35.5% for women and 38.3% for men). Results The results showed that participants undergoing CABG with lower than normal hct levels had increased blood loss through drainage as compared to participants who had normal hct levels (680.1 ± 301 mL vs. 500.7 ± 412 mL; p-value: 0.02). Group 1 participants also had an increased need for blood and blood product transfusion as compared to group 2 (3.2 ± 1.8 units vs. 1.8 ± 0.9 units; p-value: <0.0001). Furthermore, the participants in group 1 had longer stays in the ICU relative to the other group (5.2 ± 3.1 days vs. 3.4 ± 2.5 days; p-value: 0.003). Conclusion Based on our findings, patients who undergo CABG surgery with lower than normal hct levels are at increased risk of certain complications, including excessive blood loss, need for transfusion, and increased duration of ICU stay. Therefore, preoperative hct levels should be routinely checked in patients undergoing CABG to prevent these complications.
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