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Association Between Preoperative Iron Deficiency and Postoperative Outcomes in Children Undergoing Cardiac Surgery
Andrew J Matisoff1, Emily Teehan2, Marisa Signorile3
1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Anesthesiology and Pain Medicine and Physiology, University of Toronto, Toronto, Canada.
Insights
Iron deficiency is common in pediatric cardiac surgery patients and linked to more transfusions and acute kidney injury. Early detection and management are crucial for better outcomes in these high-risk children.
Area of Science:
- Pediatric Cardiology
- Hematology
- Critical Care Medicine
Background:
- Iron deficiency is a prevalent condition in children.
- Congenital heart disease and cardiac surgery can impact iron status.
- Adverse perioperative outcomes are a concern in pediatric cardiac surgery.
Purpose of the Study:
- To determine the prevalence of iron deficiency and iron deficiency anemia.
- To investigate the association between iron deficiency and adverse outcomes in children undergoing cardiac surgery with cardiopulmonary bypass.
Main Methods:
- Retrospective review of 886 pediatric patients (0-18 years) undergoing cardiac surgery.
- Screening for iron deficiency and anemia using ferritin, hemoglobin, and reticulocyte hemoglobin equivalent.
- Analysis of perioperative outcomes including red blood cell transfusions and acute kidney injury.
Main Results:
- Patients with iron deficiency showed increased perioperative red blood cell transfusion volumes and higher incidence of postoperative acute kidney injury.
- Iron deficiency anemia was associated with larger red blood cell transfusion volumes and increased risk of acute kidney injury.
- These associations remained significant after adjusting for surgical complexity and cardiopulmonary bypass time.
Conclusions:
- Iron deficiency is common in children undergoing cardiac surgery.
- Iron deficiency is associated with an increased risk of adverse perioperative outcomes.
- Further prospective research is needed to manage iron deficiency in pediatric congenital heart disease patients.
Objectives:
To determine the prevalence of iron deficiency and iron deficiency anemia and their association with adverse outcomes in children undergoing cardiac surgery with cardiopulmonary bypass.
Design:
Retrospective review.
Setting:
Single-center, academic quaternary children's hospital.
Participants:
Eight hundred eighty-six cardiac surgery patients aged 0 to 18 years at the authors' institution between 2019 and 2023.
Interventions:
None.
Measurements And Main Results:
Patients were screened for iron deficiency and anemia using ferritin, hemoglobin, and reticulocyte hemoglobin equivalent levels. Perioperative outcomes were measured and analyzed using multiple logistic and linear regression adjusting for both surgical complexity and cardiopulmonary bypass times. Patients with iron deficiency received greater perioperative red blood cell transfusion volumes (31.2 ± 36.8 mL/kg v 21.9 ± 29 mL/kg, p < 0.001) and had an increased incidence of postoperative acute kidney injury (30.2% v 20.8%, p = 0.002) than those without iron deficiency. Patients with iron deficiency anemia received larger red blood cell transfusion volumes (33 ± 33.7 mL/kg v 22 ± 29 mL/kg, p = 0.002) and were more likely to develop acute kidney injury (37% v 21%, p = 0.006) compared with those with normal iron and hemoglobin levels. These findings persisted after adjusting for age, weight, surgical complexity, and cardiopulmonary bypass time.
Conclusions:
Iron deficiency is common in children undergoing cardiac surgery and is associated with an increased risk of adverse outcomes. Future prospective studies aimed at understanding and managing iron deficiency in patients with congenital heart disease are urgently needed.
