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Abnormal Iron Status and Adverse Outcome After Elective Cardiac Surgery: A Prospective, Observational Multicenter
Yannick J J M Hazen1, Peter G Noordzij2, Guillaume S C Geuzebroek3
1Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Hospital, Breda, The Netherlands; Department of Anesthesiology, Leiden University Medical Centre, Leiden, The Netherlands.
Insights
Preoperative abnormal iron status in cardiac surgery patients increases major complication risk. It did not significantly impact packed red blood cell transfusion or new disability onset.
Area of Science:
- Cardiology
- Hematology
- Surgical Outcomes
Background:
- Preoperative iron status is crucial for patients undergoing major surgery.
- Abnormal iron status may affect surgical outcomes and recovery.
Purpose of the Study:
- To determine the incidence of abnormal iron status before elective cardiac surgery.
- To assess its association with packed red blood cell transfusion, major complications, and new disability.
Main Methods:
- Prospective, observational multicenter cohort study.
- 427 patients aged 60+ undergoing elective on-pump cardiac surgery.
- Iron status assessed preoperatively; outcomes tracked for 30-120 days.
Main Results:
- 45.2% of patients had abnormal iron status, often iron deficiency.
- Abnormal iron status was linked to a higher risk of major postoperative complications (ARR 1.7).
- No significant association found with packed red blood cell transfusion or new disability.
Conclusions:
- Preoperative abnormal iron status is a risk factor for major complications after cardiac surgery.
- Monitoring and potentially correcting iron status could improve patient outcomes.
Objectives:
To investigate the incidence of preoperative abnormal iron status and its association with packed red blood cell (PRBC) transfusion, postoperative major complications, and new onset of clinically significant disability in patients undergoing elective cardiac surgery.
Design:
A prospective, observational multicenter cohort study.
Setting:
Three cardiac surgical centers in the Netherlands between 2019 and 2021. Recruitment was on hold between March and May 2020 due to COVID-19.
Patients:
A total of 427 patients aged 60 years and older who underwent elective on-pump cardiac surgery.
Measurements And Main Results:
The primary endpoint was a 30-day PRBC transfusion. Secondary endpoints were postoperative major complications within 30 days (eg, acute kidney injury, sepsis), and new onset of clinically significant disability within 120 days of surgery. Iron status was evaluated before surgery. Abnormal iron status was present in 45.2% of patients (n = 193), and most frequently the result of iron deficiency (27.4%, n = 117). An abnormal iron status was not associated with PRBC transfusion (adjusted relative risk [ARR] 1.2; 95% CI 0.9-1.8: p = 0.227) or new onset of clinically significant disability (ARR 2.0; 95% CI 0.9-4.6: p = 0.098). However, the risk of postoperative major complications was increased in patients with an abnormal iron status (ARR 1.7; 95% CI 1.1-2.5: p = 0.012).
Conclusions:
An abnormal iron status before elective cardiac surgery was associated with an increased risk of postoperative major complications but not with PRBC transfusion or a new onset of clinically significant disability.
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