Background-The risk of preoperative anemia in patients undergoing heart surgery has not been described precisely.Specifically, the impact of low hemoglobin per se or combined with other risk factors on postoperative outcome is unknown. Thus, we determined the effects of low preoperative hemoglobin and comorbidities on postoperative adverse outcomes in patients with coronary artery bypass graft in a large comprehensive multicenter study. Methods and Results-The Multicenter Study of Perioperative Ischemia investigated 5065 patients with coronary artery bypass graft at 70 institutions worldwide, collecting Ϸ7500 data points per patient. In 4804 patients who received no preoperative transfusions, we determined the association between lowest preoperative hemoglobin levels and in-hospital cardiac and noncardiac morbidity and mortality and the impact of concomitant risk factors, assessed by EuroSCORE, on this effect. In patients with EuroSCORE Ͻ4 (nϭ2054), only noncardiac outcomes were increased, whereas patients with EuroSCORE Ն4 (nϭ2750) showed an increased incidence of all postoperative events, starting at hemoglobin Ͻ11 g/dL. Low preoperative hemoglobin was an independent predictor for noncardiac (renalϾcerebral; PϽ0.001) outcomes, whereas the increase in cardiac events was due to other factors associated with preoperative anemia. Conclusions-Anemic patients undergoing cardiac surgery have an increased risk of postoperative adverse events.Importantly, the extent of preexisting comorbidities substantially affects perioperative anemia tolerance. Therefore, preoperative risk assessment and subsequent therapeutic strategies, such as blood transfusion, should take into account both the individual level of preoperative hemoglobin and the extent of concomitant risk factors.

In this study we compared 3 methods of conducting the preanesthetic visit. We prospectively studied 197 consecutive surgical patients who were to undergo general anesthesia. The patients were randomized to a routine preanesthetic interview, a brochure plus an interview, or a self-made documentary video plus an interview. After the preanesthetic visit, the degree of patient satisfaction and information gain was quantified by a questionnaire for each method. The questions on patient satisfaction were assessed on a six-point scale, and those on information gain were assessed on a multiple-choice basis. The video plus interview group showed the highest point scores (98% of the possible maximum sum point score in patient satisfaction and 93% of the maximum sum score in information gain). In contrast, the patients of the brochure plus interview group revealed 93% for patient satisfaction and 80% for information gain, and in the standard interview group, the corresponding figures were 91% and 72%, respectively. The maximum sum scores in patient satisfaction and information gain were significantly different between the interview and the video groups, but not between the interview and the brochure groups. Therefore, these data suggest that the use of a documentary video to supplement a preoperative interview may enhance patient satisfaction and maximize information gain.

The data suggest a potential association between postoperative RBC transfusion and increased morbidity for cardiac surgery patients with low to moderate mortality risk profiles, adequate hemoglobin levels, and low bleeding rates.