The correlation between preoperative erythrocyte sedimentation rate and postoperative outcome in adult cardiac surgery

Abstract

IntroductionOver the past decades, it has been recommended that preoperative assessment mainly relies on history and physical examination rather than unnecessary laboratory tests. In Iranian hospitals, erythrocyte sedimentation rate (ESR) has been routinely measured in most of the patients awaiting major surgery, which has in turn exacted heavy costs on the health system. Therefore, the aim of the present study was to assess the preoperative routine measurement of ESR in such patients.Materials and methodsThis is a retrospective study, in which we evaluated the medical files of 620 patients. Patients older than 18 years, who had undergone elective heart surgery in our hospital in 2014, were included in the study. The data associated with demography, heart disease diagnosis, type of surgery, significant preoperative tests, delay or postponing of surgery and the reason for it, type and characteristics of the subspecialty consultation, and finally, postoperative complication and mortality rate were collected and analyzed. The patients were categorized into four groups according to ESR value: normal (<15 mm/h in females or <20 mm/h in males), moderately increased (<40 mm/h), severely increased (≥40 mm/h), and not measured.ResultsOf the 620 patients’ files, 402 were of males and 218 were of females. Demographic values and preoperative characteristics were similar in the four groups. A total of 105 consultations were given to 79 patients preoperatively, where only in five cases, the elevation in ESR was the main reason for consultation. In no other cases did the consultations result in new diagnoses. Overall, postoperative complication and mortality rate were the same in all four groups; in severely increased ESR group, on the other hand, the need for long periods of intensive care unit (ICU) and hospital stays was higher than that of other groups.ConclusionIt is concluded that elevated preoperative ESR does not cancel or defer the surgery, nor does it help diagnose a new, previously undiagnosed disease. Furthermore, it does not generally affect postoperative morbidity or mortality rate unless increased to ≥40 mm/h, where it can increase postoperative ICU and hospital stay. Ultimately, routine preoperative ESR measurement in patients is not conducive to elective heart surgery.

What is the optimal time interval between heart catheterization and surgery to prevent acute kidney injury in patients with isolated coronary artery bypass?

“…In our study, however, no relationship was found between preoperative CRP levels and postoperative AKI, but increased CRP levels on the third and seventh postoperative day were found to be an independent risk factor for the development of postoperative AKI. The erythrocyte sedimentation rate is an inexpensive, routine, and easy-to-apply preoperative test that is routinely used in patients in many health centres [25]. ESR often reflects the inflammatory status of patients, and owing to the recently defined inflammatory processes involved in the development of cardiac disease, certain studies have reported its predictive value and association with postprocedural complications [26].…”

“…The erythrocyte sedimentation rate is an inexpensive, routine, and easy-to-apply preoperative test that is routinely used in patients in many health centres [ 25 ]. ESR often reflects the inflammatory status of patients, and owing to the recently defined inflammatory processes involved in the development of cardiac disease, certain studies have reported its predictive value and association with postprocedural complications [ 26 ].…”