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Association between perioperative hemoglobin decrease and outcomes of transfusion in patients undergoing on-pump
Junhui He1, Xinhao Liu1, Li Zhou1
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Significant perioperative hemoglobin decrease (ΔHb) after cardiac surgery increases risks. Transfusion strategies for patients with ΔHb ≥ 50% or ≥ 30% (with anemia) should be carefully considered to optimize outcomes.
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.
Background:
It is unclear how perioperative hemoglobin decrease (ΔHb) influences the balance between risks and benefits of red blood cell transfusion after cardiac surgery.
Methods:
We retrospectively analyzed data on 8186 adults who underwent valve surgery and/or coronary artery bypass grafting under cardiopulmonary bypass at two large cardiology centers. We explored the potential association of ΔHb, defined relative to the preoperative level and postoperative nadir, with a composite outcome of in-hospital mortality, myocardial infarction, stroke, and acute kidney injury using multivariable logistic regression, restricted cubic spline, and piecewise-linear models.
Results:
Among 6316 patients without preoperative anemia, ΔHb ≥ 50 % was associated with an elevated risk of the composite outcome [adjusted odds ratio (aOR) 1.95, 95 % confidence interval (CI) 1.81-2.35]. Among 869 patients without preoperative anemia and with ΔHb ≥ 50 %, postoperative transfusion of no more than four units of red blood cell appeared to decrease the risk of the composite outcome, whereas transfusion of more than six units increased risk. Among 5447 patients without preoperative anemia and with ΔHb < 50 %, postoperative transfusion appeared not to decrease the risk of the composite outcome. Among 1870 patients with preoperative anemia, ΔHb ≥ 30 % significantly increased the risk of the composite outcome (aOR 1.61, 95 % CI 1.23-2.10), and this risk might be moderated by postoperative transfusion of no more than four units of red blood cell, but increased by transfusion of more than six units.
Conclusions:
ΔHb may influence the balance between risks and benefits of red blood cell transfusion after cardiac surgery.
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