Preoperative Hemoglobin Levels and Outcomes in Cardiovascular Surgical Patients; systematic review and meta-analysis
Keywords:
Thoracic Surgery, Anemia, Morbidity, Mortality
Abstract
Objective: To determine whether preoperative anemia in patients undergoing cardiovascular surgery is associated with higher mortality, renal failure, cerebrovascular accidents and cardiovascular events as compared to patients with normal preoperative levels of hemoglobin.
Methods: A systematic review and a meta-analysis of the cohort observational and of cases and control studies was conducted, exploring the association between the pre-surgical levels of hemoglobin and adverse outcomes in patients undergoing cardiovascular surgery. The MEDLINE, EMBASE, and COCHRANE data-bases up to the 50th week of 2010 were consulted. The studies that complied with the inclusion criteria were independently selected. The sources of heterogeneity among the studies were assessed, including publication bias.
Results: Of the total number of studies reviewed, 260 were identified; sufficient data could be extracted from 11 of them to combine the mortality outcome. Out of these studies, 6 were adjusted for severity and comorbidities, while the results of the remaining ones were not adjusted.
Conclusions: Anemic patients undergoing cardiac surgery have a higher risk of postoperative adverse events. There are several factors limiting the interpretation of the data, including a poor standardized definition of anemia, and the lack of studies explicitly designed to quantify the prevalence and the impact of anemia in patients with cardiovascular diseases.
References
1. Carson JL, Duff A, Poses RM, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996;348:1055-60.
2. Groenveld HF, Januzzi JL, Damman K, et al. Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol. 2008;52:818-27.
3. Hardy JF, Martineau R, Couturier A, et al. Influence of haemoglobin concentration after extracorporeal circulation on mortality and morbidity in patients undergoing cardiac surgery. Br J Anaesth. 1998;81 Suppl 1:S38-45.
4. Nelson AH, Fleisher LA, Rosenbaum SH. Relationship between postoperative anemia and cardiac morbidity in high-risk vascular patients in the intensive care unit. Crit Care Med. 1993;21:860-6.
5. McKechnie RS, Smith D, Montoye C, et al. Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention. Circulation. 2004;110:271-7.
6. Magovern JA, Sakert T, Magovern GJ, et al. A model that predicts morbidity and mortality after coronary artery bypass graft surgery. J Am Coll Cardiol. 1996;28:1147-53.
7. Zindrou D, Taylor KM, Bagger JP. Preoperative haemoglobin concentration and mortality rate after coronary artery bypass surgery. Lancet. 2002;359:1747-8.
8. Cladellas M, Bruguera J, Comin J, et al. Is pre-operative anaemia a risk marker for in-hospital mortality and morbidity after valve replacement? Eur Heart J. 2006;27:1093-9.
9. Kulier A. Anemia and morbidity and mortality in coronary bypass surgery. Curr Opin Anaesthesiol. 2007;20:57-64.
10. Karkouti K, Wijeysundera DN, Beattie WS. Risk associated with preoperative anemia in cardiac surgery: a multicenter cohort study. Circulation. 2008;117:478-84.
11. van Straten AH, Hamad MA, van Zundert AJ, et al. Preoperative hemoglobin level as a predictor of survival after coronary artery bypass grafting: a comparison with the matched general population. Circulation. 2009;120:118-25.
12. Carrascal Y, Maroto L, Rey J, et al. Impact of preoperative anemia on cardiac surgery in octogenarians. Interact Cardiovasc Thorac Surg. 2010;10:249-55.
13. Bell ML, Grunwald GK, Baltz JH, et al. Does preoperative hemoglobin independently predict short-term outcomes after coronary artery bypass graft surgery? Ann Thorac Surg. 2008;86:1415-23.
14. De Santo L, Romano G, Della Corte A, et al. Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury. J Thorac Cardiovasc Surg. 2009;138:965-70.
15. Riera M, Ibáñez J, Molina M, et al. Anemia preoperatoria en la cirugía coronaria: ¿un factor de riesgo? Med Intensiva. 2009;33:370-6.
16. Kulier A, Levin J, Moser R, et al. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation. 2007;116:471-9.
17. Fang WC, Helm RE, Krieger KH, et al. Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation. 1997;96 SupplII:194-9.
18. Ferraris VA, Ferraris SP. Risk factors for postoperative morbidity. J Thorac Cardiovasc Surg. 1996;111:731-8.
19. Rady MY, Ryan T, Starr NJ. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med. 1998;26:225-35.
20. Habib RH, Zacharias A, Schwann TA, et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg.2003;125:1438-50.
21. Drueke TBE, Eckardt KU, Frei U, et al. Does early anemia correction prevent complications of chronic renal failure? Clin Nephrol. 1999;51:1-11.
22. Hebert PC, Yetisir E, Martin C, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases?Crit Care Med. 2001;29:227-34.
23. Karkouti K, Wijeysundera DN, Yau TM, et al. The influence of baseline hemoglobin concentration on tolerance of anemia in cardiac surgery. Transfusion. 2008;48:666-72.
24. Bracey AW, Radovancevic R, Riggs SA, et al. Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome. Transfusion. 1999;39: 1070-7.
25. Mohnle P, Snyder-Ramos SA, Miao Y, et al. Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients. Intensive Care Med 2011;37:97-109.
26. Dardashti A, Ederoth P, Algotsson L, Bronden B, Luhrs C, Bjursten H. Blood transfusion after cardiac surgery: is it the patient or the transfusion that carries the risk? Acta Anaesthesiol Scand. 2011;55:952-61.
27. Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth. 2008;11:15-9.
28. Paone G, Brewer R, Theurer PF, Bell GF, Cogan CM, Prager RL. Preoperative predicted risk does not fully explain the association between red blood cell transfusion and mortality in coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2012;143:178-85.
29. Dorneles CC, Bodanese LC, Guaragna JC, et al. The impact of blood transfusion on morbidity and mortality after cardiac surgery. Rev Bras Cir Cardiovasc. 2011;26:222-9.
30. van Straten AH, Kats S, Bekker MW, et al. Risk factors for red blood cell transfusion after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2010;24:413-7.
31. van Straten AH, Bekker MW, Soliman Hamad MA, et al. Transfusion of red blood cells: the impact on short-term and longterm survival after coronary artery bypass grafting, a ten-year follow-up. Interact Cardiovasc Thorac Surg. 2010;10:37-42.
32. Roth JV. Blood transfusion and survival in cardiac surgery. Anesthesiology. 2010;112:761-2.
33. Gross I, Shander A, Waters JH. The evidence shows that allogeneic transfusion is associated with reduced survival after coronary artery bypass surgery. Anesthesiology. 2010;112:760-1.
34. Koch C, Li L, Figueroa P, Mihaljevic T, Svensson L, Blackstone EH. Transfusion and pulmonary morbidity after cardiac surgery. Ann Thorac Surg. 2009;88:1410-8.
35. Rogers MA, Blumberg N, Saint SK, Kim C, Nallamothu BK, Langa KM. Allogeneic blood transfusions explain increased mortality in women after coronary artery bypass graft surgery. Am Heart J. 2006;152:1028-34.
36. Surgenor SD, Kramer RS, Olmstead EM, et al. The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg. 2009;108:1741-6.
37. Whitson BA, Huddleston SJ, Savik K, Shumway SJ. Risk of adverse outcomes associated with blood transfusion after cardiac surgery depends on the amount of transfusion. J Surg Res.2010;158:20-7.
38. Gardner TJ. To transfuse or not to transfuse. Circulation. 2007;116:458-60.
39. Yap CH, Lau L, Krishnaswamy M, Gaskell M, Yii M. Age of trans-fused red cells and early outcomes after cardiac surgery. Ann Thorac Surg. 2008;86:554-9.
40. Engoren M, Habib RH, Hadaway J, et al. The effect on long-term survival of erythrocyte transfusion given for cardiac valve operations. Ann Thorac Surg. 2009;88:95-100.
2. Groenveld HF, Januzzi JL, Damman K, et al. Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol. 2008;52:818-27.
3. Hardy JF, Martineau R, Couturier A, et al. Influence of haemoglobin concentration after extracorporeal circulation on mortality and morbidity in patients undergoing cardiac surgery. Br J Anaesth. 1998;81 Suppl 1:S38-45.
4. Nelson AH, Fleisher LA, Rosenbaum SH. Relationship between postoperative anemia and cardiac morbidity in high-risk vascular patients in the intensive care unit. Crit Care Med. 1993;21:860-6.
5. McKechnie RS, Smith D, Montoye C, et al. Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention. Circulation. 2004;110:271-7.
6. Magovern JA, Sakert T, Magovern GJ, et al. A model that predicts morbidity and mortality after coronary artery bypass graft surgery. J Am Coll Cardiol. 1996;28:1147-53.
7. Zindrou D, Taylor KM, Bagger JP. Preoperative haemoglobin concentration and mortality rate after coronary artery bypass surgery. Lancet. 2002;359:1747-8.
8. Cladellas M, Bruguera J, Comin J, et al. Is pre-operative anaemia a risk marker for in-hospital mortality and morbidity after valve replacement? Eur Heart J. 2006;27:1093-9.
9. Kulier A. Anemia and morbidity and mortality in coronary bypass surgery. Curr Opin Anaesthesiol. 2007;20:57-64.
10. Karkouti K, Wijeysundera DN, Beattie WS. Risk associated with preoperative anemia in cardiac surgery: a multicenter cohort study. Circulation. 2008;117:478-84.
11. van Straten AH, Hamad MA, van Zundert AJ, et al. Preoperative hemoglobin level as a predictor of survival after coronary artery bypass grafting: a comparison with the matched general population. Circulation. 2009;120:118-25.
12. Carrascal Y, Maroto L, Rey J, et al. Impact of preoperative anemia on cardiac surgery in octogenarians. Interact Cardiovasc Thorac Surg. 2010;10:249-55.
13. Bell ML, Grunwald GK, Baltz JH, et al. Does preoperative hemoglobin independently predict short-term outcomes after coronary artery bypass graft surgery? Ann Thorac Surg. 2008;86:1415-23.
14. De Santo L, Romano G, Della Corte A, et al. Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury. J Thorac Cardiovasc Surg. 2009;138:965-70.
15. Riera M, Ibáñez J, Molina M, et al. Anemia preoperatoria en la cirugía coronaria: ¿un factor de riesgo? Med Intensiva. 2009;33:370-6.
16. Kulier A, Levin J, Moser R, et al. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation. 2007;116:471-9.
17. Fang WC, Helm RE, Krieger KH, et al. Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation. 1997;96 SupplII:194-9.
18. Ferraris VA, Ferraris SP. Risk factors for postoperative morbidity. J Thorac Cardiovasc Surg. 1996;111:731-8.
19. Rady MY, Ryan T, Starr NJ. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med. 1998;26:225-35.
20. Habib RH, Zacharias A, Schwann TA, et al. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg.2003;125:1438-50.
21. Drueke TBE, Eckardt KU, Frei U, et al. Does early anemia correction prevent complications of chronic renal failure? Clin Nephrol. 1999;51:1-11.
22. Hebert PC, Yetisir E, Martin C, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases?Crit Care Med. 2001;29:227-34.
23. Karkouti K, Wijeysundera DN, Yau TM, et al. The influence of baseline hemoglobin concentration on tolerance of anemia in cardiac surgery. Transfusion. 2008;48:666-72.
24. Bracey AW, Radovancevic R, Riggs SA, et al. Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome. Transfusion. 1999;39: 1070-7.
25. Mohnle P, Snyder-Ramos SA, Miao Y, et al. Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients. Intensive Care Med 2011;37:97-109.
26. Dardashti A, Ederoth P, Algotsson L, Bronden B, Luhrs C, Bjursten H. Blood transfusion after cardiac surgery: is it the patient or the transfusion that carries the risk? Acta Anaesthesiol Scand. 2011;55:952-61.
27. Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth. 2008;11:15-9.
28. Paone G, Brewer R, Theurer PF, Bell GF, Cogan CM, Prager RL. Preoperative predicted risk does not fully explain the association between red blood cell transfusion and mortality in coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2012;143:178-85.
29. Dorneles CC, Bodanese LC, Guaragna JC, et al. The impact of blood transfusion on morbidity and mortality after cardiac surgery. Rev Bras Cir Cardiovasc. 2011;26:222-9.
30. van Straten AH, Kats S, Bekker MW, et al. Risk factors for red blood cell transfusion after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2010;24:413-7.
31. van Straten AH, Bekker MW, Soliman Hamad MA, et al. Transfusion of red blood cells: the impact on short-term and longterm survival after coronary artery bypass grafting, a ten-year follow-up. Interact Cardiovasc Thorac Surg. 2010;10:37-42.
32. Roth JV. Blood transfusion and survival in cardiac surgery. Anesthesiology. 2010;112:761-2.
33. Gross I, Shander A, Waters JH. The evidence shows that allogeneic transfusion is associated with reduced survival after coronary artery bypass surgery. Anesthesiology. 2010;112:760-1.
34. Koch C, Li L, Figueroa P, Mihaljevic T, Svensson L, Blackstone EH. Transfusion and pulmonary morbidity after cardiac surgery. Ann Thorac Surg. 2009;88:1410-8.
35. Rogers MA, Blumberg N, Saint SK, Kim C, Nallamothu BK, Langa KM. Allogeneic blood transfusions explain increased mortality in women after coronary artery bypass graft surgery. Am Heart J. 2006;152:1028-34.
36. Surgenor SD, Kramer RS, Olmstead EM, et al. The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg. 2009;108:1741-6.
37. Whitson BA, Huddleston SJ, Savik K, Shumway SJ. Risk of adverse outcomes associated with blood transfusion after cardiac surgery depends on the amount of transfusion. J Surg Res.2010;158:20-7.
38. Gardner TJ. To transfuse or not to transfuse. Circulation. 2007;116:458-60.
39. Yap CH, Lau L, Krishnaswamy M, Gaskell M, Yii M. Age of trans-fused red cells and early outcomes after cardiac surgery. Ann Thorac Surg. 2008;86:554-9.
40. Engoren M, Habib RH, Hadaway J, et al. The effect on long-term survival of erythrocyte transfusion given for cardiac valve operations. Ann Thorac Surg. 2009;88:95-100.
How to Cite
1.
Oliveros-Rodríguez HO, Beltrán Linares Édgar. Preoperative Hemoglobin Levels and Outcomes in Cardiovascular Surgical Patients; systematic review and meta-analysis. Colomb. J. Anesthesiol. [Internet]. 2012 Jan. 1 [cited 2024 Apr. 19];40(1):27-33. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/861
Downloads
Download data is not yet available.
Published
2012-01-01
How to Cite
1.
Oliveros-Rodríguez HO, Beltrán Linares Édgar. Preoperative Hemoglobin Levels and Outcomes in Cardiovascular Surgical Patients; systematic review and meta-analysis. Colomb. J. Anesthesiol. [Internet]. 2012 Jan. 1 [cited 2024 Apr. 19];40(1):27-33. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/861
Issue
Section
Systematic review
Altmetric
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
