Preoperative Anemia and Outcomes in Cardiovascular Surgery: Systematic Review and Meta-Analysis

被引:106
作者
Padmanabhan, Hari
Siau, Keith
Curtis, Jason
Ng, Alex
Menon, Shyam
Luckraz, Heyman
Brookes, Matthew J.
机构
[1] Heart & Lung Ctr, Dept Gastroenterol, Wolverhampton, W Midlands, England
[2] Royal Shrewsbury Hosp, Shrewsbury Hlth Lib, Shrewsbury, Salop, England
[3] Heart & Lung Ctr, Dept Cardiothorac Anaesthesiol, Wolverhampton, W Midlands, England
[4] Amer Hosp Dubai, Heart Ctr, Cardiothorac Surg Dept, Oud Metha, U Arab Emirates
关键词
IN-HOSPITAL MORTALITY; RED-BLOOD-CELL; CARDIAC-SURGERY; TRANSFUSION REQUIREMENTS; RESTRICTIVE TRANSFUSION; HEMOGLOBIN LEVEL; RISK-FACTOR; IMPACT; ASSOCIATION; MORBIDITY;
D O I
10.1016/j.athoracsur.2019.04.108
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Preoperative anemia is common in patients scheduled for cardiac surgery. However, its effect on postoperative outcomes remains controversial. This meta-analysis aimed to clarify the impact of anemia on outcomes after cardiac surgery. Methods. A literature search was conducted on MEDLINE, Embase, Cochrane, and Web of Science databases. The primary outcome was 30-day postoperative or inhospital mortality. Secondary outcomes included acute kidney injury, stroke, blood transfusion, and infection. A meta-analytic model was used to determine the differences in the above postoperative outcomes between anemic and nonanemic patients. Results. Of 1103 studies screened, 22 met the inclusion criteria. Of 114,277 patients, 23,624 (20.6%) were anemic. Anemia was associated with increased mortality (odds ratio [OR], 2.74; 95% confidence interval [CI], 2.32-3.24; I-2 = 69.6%; P <.001), acute kidney injury (OR, 3.13; 95% CI, 2.37-4.12; I-2 = 71.1%; P <.001), stroke (OR, 1.46; 95% CI, 1.24-1.72; I-2 = 21.6%; P <.001), and infection (OR, 2.65; 95% CI, 1.98-3.55; I-2 = 46.7%; P <.001). More anemic patients were transfused than nonanemic patients (33.3% vs 11.9%, respectively). No statistically significant association was found between mortality and blood transfusion (OR, 1.35; 95% CI, 0.92-1.98; I-2 = 83.7%; P = .12), but we were not able to compare mortality with or without transfusion in those who were or were not anemic. Conclusions. Preoperative anemia is associated with adverse outcomes after cardiac surgery. These findings support the addition of preoperative anemia to future risk prediction models and as a target for risk modification. (C) 2019 by The Society of Thoracic Surgeons
引用
收藏
页码:1840 / 1848
页数:9
相关论文
共 40 条
[1]   Does Preoperative Hemoglobin Independently Predict Short-Term Outcomes After Coronary Artery Bypass Graft Surgery? [J].
Bell, Melanie L. ;
Grunwald, Gary K. ;
Baltz, Janet H. ;
McDonald, Gerald O. ;
Bell, Missy R. ;
Grover, Frederick L. ;
Shroyer, A. Laurie W. .
ANNALS OF THORACIC SURGERY, 2008, 86 (05) :1415-1423
[2]   Anemia Before Coronary Artery Bypass Surgery as Additional Risk Factor Increases the Perioperative Risk [J].
Boening, Andreas ;
Boedeker, Rolf-Hasso ;
Scheibelhut, Christine ;
Rietzschel, Juergen ;
Roth, Peter ;
Schoenburg, Markus .
ANNALS OF THORACIC SURGERY, 2011, 92 (03) :805-811
[3]   Impact of preoperative anemia on cardiac surgery in octogenarians [J].
Carrascal, Yolanda ;
Maroto, Laura ;
Rey, Juvenal ;
Arevalo, Adolfo ;
Arroyo, Jaime ;
Echevarria, Jose R. ;
Arce, Nuria ;
Fulquet, Enrique .
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY, 2010, 10 (02) :249-255
[4]   Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery [J].
Carson, Jeffrey L. ;
Terrin, Michael L. ;
Noveck, Helaine ;
Sanders, David W. ;
Chaitman, Bernard R. ;
Rhoads, George G. ;
Nemo, George ;
Dragert, Karen ;
Beaupre, Lauren ;
Hildebrand, Kevin ;
Macaulay, William ;
Lewis, Courtland ;
Cook, Donald Richard ;
Dobbin, Gwendolyn ;
Zakriya, Khwaja J. ;
Apple, Fred S. ;
Horney, Rebecca A. ;
Magaziner, Jay .
NEW ENGLAND JOURNAL OF MEDICINE, 2011, 365 (26) :2453-2462
[5]   Is pre-operative anaemia a risk marker for in-hospital mortality and morbidity after valve replacement? [J].
Cladellas, M ;
Bruguera, J ;
Comín, J ;
Vila, J ;
de Jaime, E ;
Martí, J ;
Gomez, M .
EUROPEAN HEART JOURNAL, 2006, 27 (09) :1093-1099
[6]   Preoperative Anemia in Cardiac Operation: Does Hemoglobin Tell the Whole Story? [J].
Dai, Lu ;
Mick, Stephanie L. ;
McCrae, Keith R. ;
Houghtaling, Penny L. ;
Sabik, Joseph F., III ;
Blackstone, Eugene H. ;
Koch, Colleen G. .
ANNALS OF THORACIC SURGERY, 2018, 105 (01) :100-107
[7]   Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury [J].
De Santo, Luca ;
Romano, Gianpaolo ;
Della Corte, Alessandro ;
de Simone, Vincenzo ;
Grimaldi, Francesco ;
Cotrufo, Maurizio ;
de Feo, Marisa .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2009, 138 (04) :965-970
[8]   Preoperative anaemia is a risk factor for mortality and morbidity following aortic valve surgery [J].
Elmistekawy, Elsayed ;
Rubens, Fraser ;
Hudson, Chris ;
McDonald, Bernard ;
Ruel, Marc ;
Lam, Khanh ;
Mesana, Thierry G. ;
Boodhwani, Munir .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2013, 44 (06) :1051-1056
[9]   Meta-analysis of the association between preoperative anaemia and mortality after surgery [J].
Fowler, A. J. ;
Ahmad, T. ;
Phull, M. K. ;
Allard, S. ;
Gillies, M. A. ;
Pearse, R. M. .
BRITISH JOURNAL OF SURGERY, 2015, 102 (11) :1314-1324
[10]   Transfusion Requirements After Cardiac Surgery The TRACS Randomized Controlled Trial [J].
Hajjar, Ludhmila A. ;
Vincent, Jean-Louis ;
Galas, Filomena R. B. G. ;
Nakamura, Rosana E. ;
Silva, Carolina M. P. ;
Santos, Marilia H. ;
Fukushima, Julia ;
Kalil Filho, Roberto ;
Sierra, Denise B. ;
Lopes, Neuza H. ;
Mauad, Thais ;
Roquim, Aretusa C. ;
Sundin, Marcia R. ;
Leao, Wanderson C. ;
Almeida, Juliano P. ;
Pomerantzeff, Pablo M. ;
Dallan, Luis O. ;
Jatene, Fabio B. ;
Stolf, Noedir A. G. ;
Auler, Jose O. C., Jr. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2010, 304 (14) :1559-1567