title: Decline in serum hemoglobin in the 7 days after cardiac catheterization.
abstract: OBJECTIVE
  Bleeding is an established complication following cardiac catheterization and lower preoperative hemoglobin concentration is a potentially modifiable risk factor for adverse outcomes after cardiac surgery. However, typical changes in serum hemoglobin concentration after cardiac catheterization are poorly defined. The authors sought to identify the pattern of change in serum hemoglobin concentration within 7 days after cardiovascular catheterization, factors associated with this change and any association with adverse outcomes.
  
  
  METHODS
  Retrospective observational study over a 1-year period.
  
  
  METHODS
  U.S. academic medical institution.
  
  
  METHODS
  Participants were 284 adult patients with baseline hemoglobin concentration≥12 g/dL undergoing nonemergent cardiac surgery after cardiovascular catheterization via the femoral arterial route.
  
  
  METHODS
  None.
  
  
  RESULTS
  Lowest daily hemoglobin concentration was recorded where available for up to 7 days after catheterization and before surgery. Generalized estimating equations identified the pattern of change in serum hemoglobin while regression models identified factors associated with hemoglobin decline. Following cardiovascular catheterization average serum hemoglobin declined over time, reaching a nadir 1.4 g/dL (95% CI 1.0-1.8) below baseline 6 days after catheterization. A higher baseline hemoglobin concentration and lower body mass index were associated with greater maximal decline in hemoglobin concentration after catheterization. Acute preoperative hemoglobin decline was not associated with acute kidney injury (AKI) or a composite adverse outcome that may reflect organ ischemia.
  
  
  CONCLUSIONS
  In a cohort of patients before cardiac surgery serum hemoglobin declines during the week after cardiac catheterization, with maximal average decline observed 5 to 7 days after catheterization.
authors.affiliation: Department of Anesthesiology, Columbia University College of Physicians & Surgeons, New York, NY; Department of Anaesthesia & Perioperative Medicine, Alfred Hospital & Monash University, Melbourne, Australia. Electronic address: dm2655@columbia.edu.
authors.forename: David
authors.initials: D
authors.lastname: Richard McIlroy
authors.affiliation: Department of Anesthesiology, Columbia University College of Physicians & Surgeons, New York, NY.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ankeny
authors.affiliation: Department of Anesthesiology, Columbia University College of Physicians & Surgeons, New York, NY.
authors.forename: David
authors.initials: D
authors.lastname: Farkas
authors.affiliation: Departments of Biostatistics, Columbia University, New York, NY.
authors.forename: Srikesh
authors.initials: S
authors.lastname: Arunajadai
authors.affiliation: Surgery, Division of Cardiac Surgery, Columbia University College of Physicians & Surgeons, New York, NY.
authors.forename: Tianna
authors.initials: T
authors.lastname: Umann
authors.affiliation: Department of Anaesthesia & Perioperative Medicine, Alfred Hospital & Monash University, Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D010100:Oxygen
keywords: cardiac catheterization; cardiac surgical procedures; sequelae