The incidence and importance of anaemia in patients undergoing cardiac surgery in the UK - the first Association of Cardiothoracic Anaesthetists national audit

Abstract

SummaryThe importance and variability of pre-operative anaemia in cardiac surgical patients across the UK is not known, and there is debate about its association with patient outcomes. The Association of Cardiothoracic Anaesthetists carried out its first national audit on anaemia and transfusion, and analysed data from 19,033 patients operated on in 12 cardiac surgical centres between 2010 and 2012; 5895 (31%) had pre-operative anaemia. Centre-specific prevalence of anaemia varied from 23% to 45%; anaemia was associated with older patients, diabetes and surgical risk (Euro-SCORE). Nevertheless, controlling for these factors, regional variation remained an independent effect (p < 0.001). Multivariable analysis demonstrated an independent association of anaemia with transfusion (odds ratio (95% confidence interval) 2.75 (2.55-2.95), p < 0.001), mortality (1.42 (1.18-1.71), p < 0.001) and hospital stay (geometric mean ratio (95% confidence interval) 1.15 (1.13-1.17), p < 0.001). Haemoglobin concentration per se was also independently associated with worse outcomes; a 10 g.l À1 decrease in haemoglobin was associated with a 43% increase (95% confidence interval 40-46%) in the odds of transfusion and a 16% increase (95% confidence interval 10-

The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery

“…Consequently, the transfusion practices in the specific centre may not accurately reflect general transfusion practice. This may be due to regional variation in anaemia incidence as described by Klein et al, 12 or a higher incidence of complex cardiac surgery being undertaken at this specific centre. The decision by the authors to not specifically correct for regional variation was made in order to retain generalisation, enabling the scoring system to be used at centres outside those who participated in the initial cohort.…”

“…This is considerably more complex than the simpler TRACK and ACTA-PORT prediction models. When the Goudie model was published, it represented an advance on many existing scoring systems, 10,12,15 with an AUC of 0.77 for any red blood cell transfusion. ACTA-PORT represents an improvement on Goudie et al, retaining the simplicity and accessibility of TRACK combined with a greater predictive accuracy for red cell transfusion; our validation cohort demonstrating an AUC of 0.84.…”

Post-Operative Iron Carboxymaltose May Have an Effect on Haemoglobin Levels in Cardiothoracic Surgical Patients on the ICU - an Observational Pilot Study about Anaemia Treatment with Intravenous Iron

“…In 2016, the first Cardiothoracic Anaesthetists national audit was performed in the UK. Data on anaemia and transfusion was analysed from 19,033 patients operated on in 12 cardiac surgical centres between 2010 and 2012 [15]. At average, the anaemia prevalence was 31%, but centre-specific prevalences varied from 23 to 45%.…”

“…Anaemia was associated with older patients, diabetes and surgical risk (Euro-SCORE). Patients with anaemia were twice as likely to die after cardiac surgery, and mortality was linked to severity of pre-operative anaemia and gender [15]. …”

Anaemia and cardiac surgery

“…Anaesthetists will rely on it when assessing the potential for neuraxial hematoma formation when placing or removing an epidural catheter. It is also a key component of the Model for End-stage Liver Disease (MELD) score, which is an objective means of predicting 90-day patient survival in patients on the liver transplant waiting list, and is used to prioritise donor organs to the most needy patients [1]. The accuracy of PT measurement has been questioned, as there is marked variability in the sensitivity of the thromboplastin reagents used in its determination [2].…”