title: Prevalence of preoperative anaemia in patients having first-time cardiac surgery and its impact on clinical outcome. A retrospective observational study.
abstract: The prevalence of anaemia is increasing globally. It has a close association with perioperative blood transfusion which, in turn, results in an increased risk of postoperative complications. Undesirable effects are not only limited to short-term, but also have long-term implications. Despite this, many patients undergo cardiac surgery with undiagnosed and untreated anaemia. We designed a retrospective, observational study to estimate the prevalence of anaemia in patients having cardiac surgery in Auckland District Health Board, blood transfusion rates and associated clinical outcome. Two hundred of seven hundred and twelve (28.1%) patients were anaemic. Red blood cell (RBC) transfusion rates were significantly higher in the anaemic group compared to the non-anaemic group (160 (80%) vs. 192 (38%), p-value <0.0001, RR (CI 95%) 2.133 (1.870-2.433)). Transfusion rates for fresh frozen plasma (FFP), cryoprecipitate and platelets were also higher in the anaemic group. Anaemia was significantly associated with the development of new infection (14 (7%) vs. 15 (2.9%), p-value 0.0193, RR (CI 95%) 2.389 (1.175-4.859)), prolonged ventilation time (47.01 hours vs. 23.59 hours, p-value 0.0076) and prolonged intensive care unit (ICU) stay (80.23 hours vs. 50.27, p-value 0.0011). Preoperative anaemia is highly prevalent and showed a clear link with significantly higher transfusion rates and postoperative morbidity. It is vital that a preoperative management plan for the correction of anaemia should be sought to improve patient safety and outcome.
authors.affiliation: Department of Anaesthesia. Auckland District Health Board (ADHB), Auckland, New Zealand cjk.chang@gmail.com.
authors.forename: C J
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Department of Anaesthesia and Cardiothoracic and Vascular Intensive Care Unit (CVICU). ADHB, Auckland, New Zealand.
authors.forename: H
authors.initials: H
authors.lastname: Connell
authors.affiliation: Department of Anaesthesia and Cardiothoracic and Vascular Intensive Care Unit (CVICU). ADHB, Auckland, New Zealand.
authors.forename: A D
authors.initials: AD
authors.lastname: McGeorge
authors.affiliation: ADHB Research Office. Auckland District Health Board, Auckland, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Hu
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000740:Anemia / Q000453:epidemiology / Q000628:therapy; D016913:Blood Component Transfusion; D006348:Cardiac Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology; D057234:Preoperative Period; D015995:Prevalence; D012189:Retrospective Studies
keywords: anaemia; cardiac surgery; clinical outcome; morbidity; mortality; transfusion rate