Preoperative anaemia and outcome after elective cardiac surgery: a Dutch national registry analysis,British Journal of Anaesthesia

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Preoperative anaemia and outcome after elective cardiac surgery: a Dutch national registry analysis
British Journal of Anaesthesia ( IF 9.8 ) Pub Date : 2022-01-12 , DOI: 10.1016/j.bja.2021.12.016
Yannick J J M Hazen ₁ , Peter G Noordzij ₂ , Bastiaan M Gerritse ₁ , Thierry V Scohy ₁ , Saskia Houterman ₃ , Sander Bramer ₄ , Remco R Berendsen ₅ , R Arthur Bouwman ₆ , Susanne Eberl ₇ , Johannes S E Haenen ₈ , Jan Hofland ₉ , Maarten Ter Horst ₁₀ , Marieke F Kingma ₁₁ , Jan Van Klarenbosch ₁₂ , Toni Klok ₁₃ , Marcel P J De Korte ₁₄ , Joost M A A Van Der Maaten ₁₅ , Alexander J Spanjersberg ₁₆ , Nicobert E Wietsma ₁₇ , Nardo J M van der Meer ₁₈ , Thijs C D Rettig ₁ ,

Affiliation

Department of Anaesthesiology, Intensive Care and Pain Medicine, Amphia Hospital, Breda, The Netherlands.
Department of Anaesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
Netherlands Heart Registration, Utrecht, The Netherlands.
Department of Cardiothoracic Surgery, Amphia Hospital, Breda, The Netherlands.
Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Anaesthesiology, Catharina Hospital, Eindhoven, The Netherlands.
Department of Anaesthesiology, Academic Medical Centre, Amsterdam, The Netherlands.
Department of Anaesthesiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Department of Anaesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Department of Anaesthesiology, Haga Hospital, The Hague, The Netherlands.
Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Anaesthesiology, OLVG, Amsterdam, The Netherlands.
Department of Anaesthesiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Department of Anaesthesiology, University Medical Centre Groningen, Groningen, The Netherlands.
Department of Anaesthesiology, Isala Clinic Zwolle, Zwolle, The Netherlands.
Department of Anaesthesiology, Medical Spectrum Twente, Enschede, The Netherlands.
Executive Board of Directors, Catharina Hospital, Eindhoven, The Netherlands.

Background

Previous studies have shown that preoperative anaemia in patients undergoing cardiac surgery is associated with adverse outcomes. However, most of these studies were retrospective, had a relatively small sample size, and were from a single centre. The aim of this study was to analyse the relationship between the severity of preoperative anaemia and short- and long-term mortality and morbidity in a large multicentre national cohort of patients undergoing cardiac surgery.

Methods

A nationwide, prospective, multicentre registry (Netherlands Heart Registration) of patients undergoing elective cardiac surgery between January 2013 and January 2019 was used for this observational study. Anaemia was defined according to the WHO criteria, and the main study endpoint was 120-day mortality. The association was investigated using multivariable logistic regression analysis.

Results

In total, 35 484 patients were studied, of whom 6802 (19.2%) were anaemic. Preoperative anaemia was associated with an increased risk of 120-day mortality (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI]: 1.4–1.9; P<0.001). The risk of 120-day mortality increased with anaemia severity (mild anaemia aOR 1.6; 95% CI: 1.3–1.9; P<0.001; and moderate-to-severe anaemia aOR 1.8; 95% CI: 1.4–2.4; P<0.001). Preoperative anaemia was associated with red blood cell transfusion and postoperative morbidity, the causes of which included renal failure, pneumonia, and myocardial infarction.

Conclusions

Preoperative anaemia was associated with mortality and morbidity after cardiac surgery. The risk of adverse outcomes increased with anaemia severity. Preoperative anaemia is a potential target for treatment to improve postoperative outcomes.

中文翻译：

择期心脏手术后的术前贫血和结果：荷兰国家登记分析

背景

先前的研究表明，接受心脏手术的患者术前贫血与不良结局相关。然而，这些研究大多是回顾性的，样本量相对较小，并且来自单一中心。本研究的目的是在一个接受心脏手术的大型多中心国家队列中分析术前贫血的严重程度与短期和长期死亡率和发病率之间的关系。

方法

这项观察性研究使用了一项针对 2013 年 1 月至 2019 年 1 月期间接受择期心脏手术的患者的全国性、前瞻性、多中心登记（荷兰心脏登记）。贫血根据WHO标准定义，主要研究终点为120天死亡率。使用多变量逻辑回归分析研究该关联。

结果

总共研究了 35 484 名患者，其中 6802 名（19.2%）患有贫血。术前贫血与 120 天死亡率风险增加相关（调整优势比 [aOR] 1.7；95% 置信区间 [CI]：1.4-1.9；P <0.001）。120 天死亡率的风险随着贫血严重程度的增加而增加（轻度贫血 aOR 1.6；95% CI：1.3-1.9；P <0.001；中度至重度贫血 aOR 1.8；95% CI：1.4-2.4；P <0.001 ）。术前贫血与红细胞输注和术后发病率有关，其原因包括肾衰竭、肺炎和心肌梗死。