Preoperative Anemia and Outcomes in Cardiovascular Surgery: Systematic Review and Meta-Analysis

Padmanabhan, Hari; Siau, Keith; Curtis, Jason; Ng, Alex; Menon, Shyam; Luckraz, Heyman; Brookes, Matthew

doi:10.1016/j.athoracsur.2019.04.108

Cited by 103 publications

(84 citation statements)

References 36 publications

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“…These research groups involved patients undergoing rectal cancer surgery, cardiac surgery [3,13,23,24], hepatectomy [4], singlelevel lumbar surgery [25]. Others objected to the above points, insisting that anemia is an important predictor of 30day mortality, mainly in patients undergoing cardiovascular surgery [5][6][7]12]. However, studies on multidisciplinary surgical populations for non-cardiac surgery are limited.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that the relationship between them is no statistically significant in patients undergoing rectal cancer surgery [2], cardiac surgery [3], hepatectomy [4], single-level lumbar surgery [4]. And conversely, some studies pointing out that anemia is an important predictor of 30day mortality in the patients undergoing, cardiovascular [5][6][7], spine tumors [8], major abdominal [9] , joint arthroplasty [10], gastrointestinal surgery [11], vascular surgery [12], and thyroidectomy [13]. Little is known about the effects of anemia in the perioperative prognosis in non-cardiac surgery patients over 18 years of age, with two related studies involving children [14] and the elderly [15].…”

Section: Introductionmentioning

confidence: 99%

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Anemia and perioperative mortality in non-cardiac surgery patients: a secondary analysis based on a single-center retrospective study

Luo

et al. 2020

BMC Anesthesiol

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Background: Evidence regarding the relationship between anemia and perioperative prognosis is controversial. The study was conducted to highlight the specific relationship between anemia and perioperative mortality in noncardiac surgery patients over 18 years of age. Methods: This study was a retrospective analysis of the electronic medical records of 90,784 patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. Multivariate regression, propensity score analysis, doubly robust estimation, and an inverse probability-weighting model was used to ensure the robustness of our findings. Results: We identified 85,989 patients, of whom75, 163 had none or mild anemia (Hemoglobin>90g/L) and 10,826 had moderate or severe anemia (Hemoglobin≤90g/L). 8,857 patients in each study exposure group had similar propensity scores and were included in the analyses. In the doubly robust model, postoperative 30-day mortality rate was increased by 0.51% (n = 219) in moderate or severe anemia group (Odds Ratio, 1.510; 95% Confidence Interval (CI), 1.049 to 2.174) compared with none or mild anemia group (2.47% vs.1.22%, P<0.001). Moderate or severe anemia was also associated with increased postoperative blood transfusion rates (OR, 5.608; 95% CI, 4.026 to 7.811, P < 0.001). There was no statistical difference in Intensive Care Unit (ICU) admission rate among different anemia groups within 30 days after surgery (P=0.104). Discussion: In patients undergoing non-cardiac surgery over 18 years old, moderate or severe preoperative anemia would increase the occurrence of postoperative blood transfusion and the risk of death, rather than ICU admission within 30 days after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anemia and perioperative mortality in non-cardiac surgery patients: a secondary analysis based on a single-center retrospective study

Luo

et al. 2020

BMC Anesthesiol

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“…Fourteen reports, including close to 900,000 patients, identified, but eight reports (including close to 60,000 patients) did not identify anaemia as an independent risk factor for mortality [23]. A meta-analysis of 22 studies and 114,277 patients showed a HR of 2.74 (95% CI 2.32-3.24) for 30-d or in-hospital mortality after cardiac surgery in anaemic patients [24]. In a study on possible predictors for 30-d mortality after mitral valve replacement, the only independent risk factor was haematocrit level (p ¼ .017) [25].…”

Section: Discussionmentioning

confidence: 94%

Preoperative atrial fibrillation in association with reduced haemoglobin predicts increased 30-d mortality after cardiac surgery

Räsänen

Juutilainen

Halonen

2020

Scandinavian Cardiovascular Journal

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“…These research groups involved patients undergoing rectal cancer surgery, cardiac surgery [3,13,23,24] , hepatectomy [4] , single-level lumbar surgery [25] . Others objected to the above points, insisting that anemia is an important predictor of 30day mortality, mainly in patients undergoing cardiovascular surgery [5][6][7]12] . However, studies on multidisciplinary surgical populations for non-cardiac surgery are limited.…”

Section: Discussionmentioning

confidence: 99%

Anemia and perioperative mortality in Non-cardiac Surgery patients: a secondary analysis based on a single-center retrospective study

Luo

et al. 2020

Preprint

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Background : Evidence regarding the relationship between anemia and perioperative prognosis is controversial. The study was conducted to highlight the specific relationship between anemia and perioperative mortality in non-cardiac surgery patients over 18 years of age. Methods: This study was a retrospective analysis of the electronic medical records of 90,784 patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. Multivariate regression, propensity score analysis, doubly robust estimation, and an inverse probability-weighting model was used to ensure the robustness of our findings. Results : We identified 85,989 patients, of whom75, 163 had none or mild anemia(Hemoglobin>90g/L) and 10,826 had moderate or severe anemia(Hemoglobin≤90g/L). 8,857 patients in each study exposure group had similar propensity scores and were included in the analyses. In the doubly robust model, postoperative 30-day mortality rate was increased by 0.51% (n = 219) in moderate or severe anemia group (Odds Ratio, 1.510; 95% Confidence Interval(CI), 1.049 to 2.174) compared with none or mild anemia group (2.47% vs. 1.22%, P<0.001). Moderate or severe anemia was also associated with increased postoperative blood transfusion rates (OR, 5.608; 95% CI, 4.026 to 7.811, P < 0.001).There was no statistical difference in Intensive Care Unit(ICU) admission rate among different anemia groups within 30 days after surgery (P=0.104). Discussion: In patients undergoing non-cardiac surgery over 18 years old, moderate or severe preoperative anemia would increase the occurrence of postoperative blood transfusion and the risk of death, rather than ICU admission within 30 days after surgery.

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Preoperative Anemia and Outcomes in Cardiovascular Surgery: Systematic Review and Meta-Analysis

Cited by 103 publications

References 36 publications

Anemia and perioperative mortality in non-cardiac surgery patients: a secondary analysis based on a single-center retrospective study

Anemia and perioperative mortality in non-cardiac surgery patients: a secondary analysis based on a single-center retrospective study

Preoperative atrial fibrillation in association with reduced haemoglobin predicts increased 30-d mortality after cardiac surgery

Anemia and perioperative mortality in Non-cardiac Surgery patients: a secondary analysis based on a single-center retrospective study

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