Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery

Shirzad, Mahmood; Karimi, Abbasali; Dowlatshahi, Samaneh; Ahmadi, Seyed Hossein; Davoodi, Saeed; Marzban, Mehrab; Movahedi, Namvar; Abbasi, Kyomars; Tazik, Mokhtar; Fathollahi, Mahmood Sheikh

doi:10.2478/s11536-009-0094-6

Cited by 7 publications

(14 citation statements)

References 31 publications

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“…Characteristics of the included studies are summarized in Table . A total of 949 445 patients were included, and all 24 studies reported the primary outcome of 30‐day or in‐hospital mortality.…”

Section: Resultsmentioning

confidence: 99%

“…However, stroke and myocardial infarction were reported as an outcome only in studies of patients undergoing cardiac surgery ( Table ). A haemoglobin definition was used in 17 studies, a haematocrit definition in six studies, and both definitions were used in one study. Definitions of anaemia ranged from a haemoglobin concentration of 11 to 12 g/dl or a haematocrit of 30–39 per cent for female patients, and from 11 to 14 g/dl or 30–39 per cent respectively for male patients.…”

Section: Resultsmentioning

confidence: 99%

“…S2 , supporting information). Patients who received an allogeneic red cell transfusion were excluded from one study, and one article reported allogeneic red cell transfusion rates only for anaemic patients. Statistical adjustment was carried out in all included studies, but the method used and variables included in models were too varied to allow separate analysis.…”

Section: Resultsmentioning

confidence: 99%

“…When restricted to the 13 studies reporting the WHO definition, 21 322 (29⋅9 per cent) of 71 338 patients were anaemic. Thirteen studies reported the incidence of allogeneic red cell transfusion ( 26 Cladellas et al 22 Wu et al 40 Bell et al 20 Beattie et al 19 Melis et al 30 De Santo et al 23 Shirzad et al 37 Munoz et al 31 Musallam et al 32 Boening et al 21 Vochteloo et al 39 Hung et al 28 Dubljanin-Raspopovic et al 24 Greenky et al 25 Ranucci et al 34 Oshin and Torella 33 Saager et al 35 Gupta et al 27 van Straten et al 38 Seicean et al 36 Jung et al 29 Zhang et al 41 Baron et al 5 Total Heterogeneity: τ 2 = 0·24; χ 2 = 768·79, 22 d.f., P < 0·001; I 2 = 97% Test for overall effect: Z = 8·88, P < 0·001 Cladellas et al 22 Bell et al 20 De Santo et al 23 Munoz et al 31 Musallam et al 32 Boening et al 21 Ranucci et al 34 Zhang et al Cladellas et al 22 Bell et al 20 De Santo et al 23 Munoz et al 31 Boening et al 21 Ranucci et al 34 Total Heterogeneity:…”

Section: Frequency Of Anaemia and Blood Transfusionmentioning

confidence: 99%

“…S2, supporting information). Patients who received an allogeneic red cell transfusion were excluded from one study 37 , and one article reported allogeneic red cell transfusion rates only for anaemic patients 33 .…”

Section: Myocardial Infarctionmentioning

confidence: 99%

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Meta-analysis of the association between preoperative anaemia and mortality after surgery

Fowler

Ahmad

Phull

et al. 2015

British Journal of Surgery

406

294

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Frequency Of Anaemia and Blood Transfusionmentioning

confidence: 99%

Section: Myocardial Infarctionmentioning

confidence: 99%

See 3 more Smart Citations

Meta-analysis of the association between preoperative anaemia and mortality after surgery

Fowler

Ahmad

Phull

et al. 2015

British Journal of Surgery

406

294

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Patient Blood Management

Mueller

Remoortel

Meybohm

et al. 2019

JAMA

426

146

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IMPORTANCE Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. OBJECTIVE To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. EVIDENCE REVIEWThe scientific committee developed 17 Population/Intervention/ Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018.FINDINGS From 17 607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23 143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. CONCLUSIONS AND RELEVANCEThe 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.

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Mortality across the spectrum of hemoglobin level in patients undergoing surgical coronary revascularization

Khalaji

Ajam

Sheikhy

et al. 2023

Clinical Cardiology

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Background Preoperative hemoglobin (Hb) level is a predictor of in‐hospital and midterm mortality in patients undergoing coronary artery bypass grafting surgery (CABG). However, the debate about the different hazards across Hb levels and sex differences in outcome occurrence is still on the table. Methods This is a registry‐based serial cross‐sectional study at Tehran Heart Center. Nonanemic patients who underwent CABG with complete follow‐up data were included. The Restricted Cubic Splines (RCS) in the Cox model was used to calculate the sex‐specific correlation between in‐hospital, 6‐month, and 1‐year mortalities and normal Hb levels using odds ratio for the in‐hospital and hazard ratios for 6‐month and 1‐year mortality, adjusted for all possible confounders. Results From 2005 to 2016, a total of 13,557 patients were included, of which 134 had in‐hospital mortality as our primary outcome. Preoperative Hb levels were significantly lower in the deceased. Moreover, dead patients had significantly higher rates of diabetes and hypertension, while lower ejection fraction. Cut‐offs for reference Hb level were higher for males compared with females. The correlation between Hb level and in‐hospital mortality was nearly U‐shaped. Quantitatively, Hb of ≥15.62 and ≤13.25 g/dL for men and that of ≥14.92 and ≤13.4 g/dL for women tended to be associated with higher in‐hospital mortality. Conclusions The association between preoperative Hb level and in‐hospital mortality differs in men and women and does not follow a linear correlation among nonanemic patients. Both low and high numbers in the Hb level spectrum are at greater risk.

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Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery

Cited by 7 publications

References 31 publications

Meta-analysis of the association between preoperative anaemia and mortality after surgery

Meta-analysis of the association between preoperative anaemia and mortality after surgery

Patient Blood Management

Mortality across the spectrum of hemoglobin level in patients undergoing surgical coronary revascularization

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