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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.
Insights
Preoperative iron-deficiency anemia in cardiac surgery patients significantly increases mortality and healthcare use. Early detection and management are crucial for improving patient outcomes after procedures like coronary artery bypass grafting.
Area of Science:
- Cardiology
- Hematology
- Surgical Outcomes Research
Background:
- Iron-deficiency anemia (IDA) is a common comorbidity.
- Its prevalence and impact on cardiac surgery outcomes require further elucidation.
Purpose of the Study:
- To determine the prevalence of preoperative IDA in cardiac surgery patients.
- To assess the association between IDA and patient survival and healthcare resource utilization.
Main Methods:
- Retrospective cohort study of 5,960 adult patients undergoing coronary artery bypass grafting or valve surgery.
- Analysis of associations between IDA, survival, and resource utilization using Cox proportional hazards, quantile regression, and negative binomial regression.
Main Results:
- Patients with IDA had significantly higher 30-day and 365-day mortality compared to nonanemic patients.
- IDA was linked to longer intensive care unit and hospital stays, fewer days alive at home, and increased emergency department visits.
- IDA also showed worse outcomes compared to unspecified anemia.
Conclusions:
- Preoperative IDA is a significant independent predictor of decreased survival and increased healthcare utilization in cardiac surgery.
- These findings underscore the importance of screening for and managing IDA before cardiac procedures.
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.
