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Preoperative anemia and transfusion in cardiac surgery: a single-centre retrospective study
Quynh Nguyen1, Eric Meng2, Joel Berube2
1Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Insights
Preoperative anemia affects 15% of elective cardiac surgery patients, leading to a 53% transfusion rate. Key predictors include hemoglobin, eGFR, BSA, and bypass time. Early intervention is crucial but infrequently utilized.
Area of Science:
- Cardiology
- Anesthesiology
- Transfusion Medicine
Background:
- Preoperative anemia and blood transfusion are linked to adverse outcomes in surgery.
- Identifying anemia prevalence and transfusion predictors is vital for improving patient care.
- Evaluating preoperative intervention programs can optimize outcomes.
Purpose of the Study:
- To determine the prevalence of preoperative anemia in elective cardiac surgery.
- To identify predictors of blood transfusion on surgery day.
- To assess the effectiveness of the preoperative intervention program and anemia treatment window.
Main Methods:
- A study involving 797 adult patients undergoing elective cardiac surgery at a tertiary hospital.
- Multivariable logistic regression analysis was employed to identify transfusion predictors.
- Analysis of patient data including hemoglobin, eGFR, BSA, and cardiopulmonary bypass time.
Main Results:
- Preoperative anemia was identified in 15% of patients, with a 53% transfusion rate compared to 10% in non-anemic patients.
- Hemoglobin, eGFR, BSA, and cardiopulmonary bypass time were significant predictors of transfusion.
- Only 8% of anemic patients were referred to a blood conservation clinic, and treatment initiated in only 3%.
Conclusions:
- Preoperative anemia is prevalent (15%) in elective cardiac surgery patients, significantly increasing transfusion rates (53%).
- Hemoglobin, eGFR, BSA, and cardiopulmonary bypass time are key predictors of transfusion.
- Current preoperative anemia management and intervention referral rates are low, indicating a need for program improvement.
Background:
Preoperative anemia and transfusion are associated with worse outcomes. This study aims to identify the prevalence of preoperative anemia, transfusion rates on surgery day, and predictors of transfusion in elective cardiac surgery patients at our centre. We also aim to evaluate our preoperative intervention program, and examine the intervention window for anemia before surgery.
Methods:
This study included 797 adult patients who underwent elective cardiac surgery at a tertiary hospital. Multivariable logistic regression analysis was used to identify predictors of transfusion on surgery day.
Results:
Preoperative anemia was present in 15% of patients. Anemic patients had a significantly higher transfusion rate at 53% compared to 10% in non-anemic patients. Hemoglobin concentration, estimated glomerular filtration rate (eGFR), body surface area (BSA), and total cardiopulmonary bypass time were predictive of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day, however, referral to the blood conservation clinic was only done for 8% of anemic patients and treatment was initiated in 3% of anemic patients. Among the 3 anemic patients who received treatment, 2 did not require blood transfusion on surgery day.
Conclusions:
Preoperative anemia is present in 15% of patients at our centre and these patients have 53% transfusion rates on surgery day. Hemoglobin concentration, eGFR, BSA, and total cardiopulmonary bypass time were predictors of transfusion on surgery day. Patients had a median of 7 days between initial visit and surgery day. Referral and anemia treatment were infrequently initiated in preoperative anemic patient.
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