Association between perioperative hemoglobin decrease and outcomes of transfusion in patients undergoing on-pump...

Area of Science:

• Cardiology
• Transfusion Medicine
• Critical Care Medicine

Background:

• The impact of perioperative hemoglobin decrease (ΔHb) on red blood cell (RBC) transfusion risks and benefits post-cardiac surgery remains unclear.
• Understanding this relationship is crucial for optimizing patient management and transfusion protocols.

Purpose of the Study:

• To investigate the association between perioperative hemoglobin decrease (ΔHb) and adverse outcomes following cardiac surgery.
• To evaluate how red blood cell transfusion strategies modify these risks based on the degree of ΔHb and preoperative anemia status.

Main Methods:

• Retrospective analysis of 8186 adult patients undergoing valve surgery and/or coronary artery bypass grafting.
• Exploration of ΔHb (relative to preoperative levels and postoperative nadir) association with composite outcomes (mortality, MI, stroke, AKI).
• Utilized multivariable logistic regression, restricted cubic spline, and piecewise-linear models for analysis.

Main Results:

• In patients without preoperative anemia, ΔHb ≥ 50% elevated composite outcome risk (aOR 1.95).
• For those with ΔHb ≥ 50%, ≤4 RBC units appeared protective, while >6 units increased risk.
• In patients with preoperative anemia, ΔHb ≥ 30% significantly increased risk (aOR 1.61), with transfusion effects similar to the non-anemic group.

Conclusions:

• Perioperative hemoglobin decrease (ΔHb) significantly influences the risk-benefit balance of red blood cell transfusion after cardiac surgery.
• Transfusion thresholds and amounts should be individualized based on ΔHb levels and preoperative anemia status to mitigate adverse outcomes.