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Ann Thorac Surg. 2019 Sep;108(3):687-692. doi: 10.1016/j.athoracsur.2019.04.044. Epub 2019 Jun 4.

Association Between Anemia and Blood Transfusion With Long-term Mortality After Cardiac Surgery.

Author information

1
Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom. Electronic address: hari.padmanabhan@nhs.net.
2
Department of Gastroenterology, Royal Wolverhampton NHS Trust and University of Wolverhampton, Wolverhampton, United Kingdom.
3
Department of Education Health and Wellbeing, University of Wolverhampton, Walsall, United Kingdom.
4
Cardiothoracic Surgery Department, Heart Centre, American Hospital Dubai, Oud Metha, Dubai, United Arab Emirates.

Abstract

BACKGROUND:

Preoperative anemia and red blood cell (RBC) transfusion are both associated with in-hospital mortality after cardiac surgery. The aim of this study was to investigate the interactions between preoperative anemia and RBC transfusion and their effect on the long-term survival of patients undergoing cardiac surgery.

METHODS:

Between 2005 and 2012, 1170 patients with anemia who underwent elective or urgent cardiac surgery were included. A matched group of 1170 nonanemic patients was used as a control group. A binary logistic regression model was used.

RESULTS:

The median follow-up period was 64 months (range, 0-127). Anemic patients had higher mortality (45%, n = 526) than nonanemic patients (32%, n = 374; P < .001). Preoperative anemia was independently associated with long-term mortality (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.46-2.1; P < .001), with both moderate (OR, 2.27; 95% CI, 1.72-2.99; P < .001) and mild anemia (OR, 1.39; 95% CI, 1.13-1.71; P = .002) contributing significantly. RBC transfusion was not associated with long-term mortality (OR, 1.07; 95% CI, 0.88-1.31; P = .49). There was no interaction between preoperative anemia and RBC transfusion (P = .947).

CONCLUSIONS:

Long-term mortality is significantly high in patients who are anemic, regardless of their transfusion status. Preoperative anemia is a strong, independent predictor of mortality and therefore should be managed before cardiac surgery.

[Indexed for MEDLINE]

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