PMID- 29706372
STAT- In-Data-Review
LR  - 20190610
IS  - 1097-685X (Electronic)
IS  - 0022-5223 (Linking)
VI  - 156
IP  - 1
DP  - 2018 Jul
TI  - Preoperative anemia versus blood transfusion: Which is the culprit for worse
      outcomes in cardiac surgery?
PG  - 66-74.e2
LID - S0022-5223(18)30890-0 [pii]
LID - 10.1016/j.jtcvs.2018.03.109 [doi]
AB  - BACKGROUND: Reducing blood product utilization after cardiac surgery has become a
      focus of perioperative care as studies have suggested improved outcomes. The
      relative impact of preoperative anemia versus packed red blood cells (PRBC)
      transfusion on outcomes remains poorly understood, however. In this study, we
      investigated the relative association between preoperative hematocrit (Hct) level
      and PRBC transfusion on postoperative outcomes after coronary artery bypass
      grafting (CABG) surgery. METHODS: Patient records for primary, isolated CABG
      operations performed between January 2007 and December 2017 at 19 cardiac surgery
      centers were evaluated. Hierarchical logistic regression modeling was used to
      estimate the relationship between baseline preoperative Hct level as well as PRBC
      transfusion and the likelihoods of postoperative mortality and morbidity,
      adjusted for baseline patient risk. Variable and model performance
      characteristics were compared to determine the relative strength of association
      between Hct level and PRBC transfusion and primary outcomes. RESULTS: A total of 
      33,411 patients (median patient age, 65 years; interquartile range [IQR], 57-72
      years; 26% females) were evaluated. The median preoperative Hct value was 39%
      (IQR, 36%-42%), and the mean Society of Thoracic Surgeons (STS) predicted risk of
      mortality was 1.8 +/- 3.1%. Complications included PRBC transfusion in 31% of
      patients, renal failure in 2.8%, stroke in 1.3%, and operative mortality in 2.0%.
      A strong association was observed between preoperative Hct value and the
      likelihood of PRBC transfusion (P < .001). After risk adjustment, PRBC
      transfusion, but not Hct value, demonstrated stronger associations with
      postoperative mortality (odds ratio [OR], 4.3; P < .0001), renal failure (OR 6.3;
      P < .0001), and stroke (OR, 2.4; P < .0001). A 1-point increase in preoperative
      Hct was associated with decreased probabilities of mortality (OR, 0.97; P =
      .0001) and renal failure (OR, 0.94; P < .0001). The models with PRBC had superior
      predictive power, with a larger area under the curve, compared with Hct for all
      outcomes (all P < .01). Preoperative anemia was associated with up to a 4-fold
      increase in the probability of PRBC transfusion, a 3-fold increase in renal
      failure, and almost double the mortality. CONCLUSIONS: PRBC transfusion appears
      to be more closely associated with risk-adjusted morbidity and mortality compared
      with preoperative Hct level alone, supporting efforts to reduce unnecessary PRBC 
      transfusions. Preoperative anemia independently increases the risk of
      postoperative morbidity and mortality. These data suggest that preoperative Hct
      should be included in the STS risk calculators. Finally, efforts to optimize
      preoperative hematocrit should be investigated as a potentially modifiable risk
      factor for mortality and morbidity.
CI  - Copyright (c) 2018 The American Association for Thoracic Surgery. Published by
      Elsevier Inc. All rights reserved.
FAU - LaPar, Damien J
AU  - LaPar DJ
AD  - University of Virginia, Charlottesville, Va.
FAU - Hawkins, Robert B
AU  - Hawkins RB
AD  - University of Virginia, Charlottesville, Va.
FAU - McMurry, Timothy L
AU  - McMurry TL
AD  - University of Virginia, Charlottesville, Va.
FAU - Isbell, James M
AU  - Isbell JM
AD  - University of Virginia, Charlottesville, Va.
FAU - Rich, Jeffrey B
AU  - Rich JB
AD  - Sentara Heart Hospital, Norfolk, Va.
FAU - Speir, Alan M
AU  - Speir AM
AD  - Inova Heart and Vascular Institute, Falls Church, Va.
FAU - Quader, Mohammed A
AU  - Quader MA
AD  - Virginia Commonwealth University, Richmond, Va.
FAU - Kron, Irving L
AU  - Kron IL
AD  - University of Virginia, Charlottesville, Va.
FAU - Kern, John A
AU  - Kern JA
AD  - University of Virginia, Charlottesville, Va.
FAU - Ailawadi, Gorav
AU  - Ailawadi G
AD  - University of Virginia, Charlottesville, Va. Electronic address:
CN  - Investigators for the Virginia Cardiac Services Quality Initiative
LA  - eng
GR  - UM1 HL088925/HL/NHLBI NIH HHS/United States
PT  - Journal Article
DEP - 20180404
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
PMC - PMC6093299
MID - NIHMS963572
OT  - anemia
OT  - cardiac
OT  - hematocrit
OT  - transfusion
EDAT- 2018/05/01 06:00
MHDA- 2018/05/01 06:00
CRDT- 2018/05/01 06:00
PMCR- 2019/07/01 00:00
PHST- 2015/05/14 00:00 [received]
PHST- 2018/02/05 00:00 [revised]
PHST- 2018/03/02 00:00 [accepted]
PHST- 2019/07/01 00:00 [pmc-release]
PHST- 2018/05/01 06:00 [pubmed]
PHST- 2018/05/01 06:00 [medline]
PHST- 2018/05/01 06:00 [entrez]
AID - S0022-5223(18)30890-0 [pii]
AID - 10.1016/j.jtcvs.2018.03.109 [doi]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 2018 Jul;156(1):66-74.e2. doi:
      10.1016/j.jtcvs.2018.03.109. Epub 2018 Apr 4.