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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.

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Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom. Electronic address:
Department of Gastroenterology, Royal Wolverhampton NHS Trust and University of Wolverhampton, Wolverhampton, United Kingdom.
Department of Education Health and Wellbeing, University of Wolverhampton, Walsall, United Kingdom.
Cardiothoracic Surgery Department, Heart Centre, American Hospital Dubai, Oud Metha, Dubai, United Arab Emirates.



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.


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.


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).


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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