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Published on: March 27, 2018
Preoperative Iron-Deficiency Anemia and Survival After Cardiac Surgery: A Retrospective Cohort Study
Jamal Alkadri1, Maggie Chen2, Keyvan Karkouti3
1Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada.
Objectives:
To describe preoperative testing for iron-deficiency anemia in cardiac surgery, including its prevalence and impact on outcomes.
Design:
Retrospective cohort study.
Setting:
Single academic center.
Participants:
A total of 5,960 consecutive adults undergoing coronary artery bypass grafting (CABG), valve, or combined CABG/valve surgery, of whom 338 (5.7%) had iron-deficiency anemia, 1,918 (32.2%) had unspecified anemia, and 3,704 (62.1%) had no anemia.
Interventions:
None.
Measurements And Main Results:
Associations between preoperative iron-deficiency anemia (ferritin ≤100 µg/L or ferritin ≤300 µg/L and transferrin saturation ≤20%), survival at 30 and 365 days, and resource utilization were analyzed using Cox proportional hazards, quantile regression, and negative binomial regression. After adjustment, compared to nonanemic patients, those with iron-deficiency anemia had higher 30-day (hazard ratio [HR], 1.91; 95% confidence interval [CI], 1.22 to 2.98; p = 0.004) and 365-day mortality (HR, 2.78; 95% CI, 2.13 to 3.62; p < 0.001), longer intensive care unit (HR, 0.84; 95% CI, 0.76 to 0.94; p = 0.002) and hospital length of stay (HR, 0.75; 95% CI, 0.68 to 0.83; p < 0.001), decreased median days alive at home (-3.71; 95% CI, -7.16 to -0.27; p = 0.03), and higher risk of emergency department (ED) visits at 1 year (incident rate ratio [IRR], 1.36; 95% CI, 1.15 to 1.61; p < 0.001). Iron-deficiency anemia was also associated with higher 365-day mortality (HR, 1.48; 95% CI, 1.17 to 1.88; p = 0.001) and ED visits at 1 year (IRR, 1.26; 95% CI, 1.07 to 1.50; p = 0.007) compared to unspecified anemia.
Conclusions:
Among cardiac surgery patients, preoperative iron-deficiency anemia is associated with decreased survival and higher health care utilization compared to patients with no anemia and unspecified anemia.
