title: Should asymptomatic patients discharged with lower hemoglobin expect worse outcomes after valve surgery?
abstract: OBJECTIVE
  Blood transfusion in cardiac surgery patients is associated with increased morbidity and cost. The decision to transfuse patients after surgery varies but is often based on low hemoglobin (Hgb) levels, regardless of symptom status. This study examined whether asymptomatic patients discharged with lower Hgb levels had increased risk for perioperative complications and 1-year mortality.
  
  
  METHODS
  Between 2008 and mid-2014, a total of 1107 valve-only procedures were performed. Patients discharged alive with complete data (N = 1044) were divided into 2 groups with discharge Hgb levels of ≤8 g/dL (n = 153) or >8 g/dL (n = 891). Propensity score matching was conducted between Hgb groups, resulting in 152 patient pairs.
  
  
  RESULTS
  In multivariate analyses, discharge Hgb level did not predict 30-day mortality (odds ratio [OR] = 1.01, P = .991), 1-year survival (hazard ratio [HR] = 0.87, P = .34), or readmission <30 days (OR = 0.92, P = .31). Furthermore, after propensity score matching, no differences were found between groups with Hgb levels ≤8 versus >8 g/dL in 30-day mortality (0% vs 0.7%, P > .99) or readmissions (14% vs 16%, P = .52). Cumulative 1-year survival was similar between matched groups with discharge Hgb level of ≤8 versus >8 g/dL (89.3% vs 91.4%, P = .67). Matched groups with Hgb level ≤8 versus >8 g/dL had similar physical (28% vs 18% increase; P = .27) and mental (7% vs 6% increase; P = .94) health-related quality of life (HRQL) improvements at 6 months.
  
  
  CONCLUSIONS
  Asymptomatic patients discharged with lower Hgb levels did not manifest inferior outcomes, including perioperative morbidity/mortality, readmission <30 days, HRQL, and 1-year survival. The practice of blood transfusion to correct lower Hgb levels in asymptomatic patients should be eliminated, as it may be associated with increased morbidity without apparent clinical benefits after valve surgery.
authors: Cardiac Surgery Research Department at Inova Heart and Vascular Institute, Falls Church, Va. Electronic address: Niv.Ad@inova.org.
authors: Niv
authors: N
authors: Ad
authors: Cardiac Surgery Research Department at Inova Heart and Vascular Institute, Falls Church, Va.
authors: Sari D
authors: SD
authors: Holmes
authors: Cardiac Surgery Research Department at Inova Heart and Vascular Institute, Falls Church, Va.
authors: Deborah J
authors: DJ
authors: Shuman
authors: Cardiac Surgery Research Department at Inova Heart and Vascular Institute, Falls Church, Va.
authors: Alan M
authors: AM
authors: Speir
authors: Cardiac Surgery Research Department at Inova Heart and Vascular Institute, Falls Church, Va.
authors: Graciela
authors: G
authors: Pritchard
authors: Cardiac Surgery Research Department at Inova Heart and Vascular Institute, Falls Church, Va.
authors: Linda
authors: L
authors: Halpin
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006351:Heart Valves / Q000601:surgery*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D011237:Predictive Value of Tests; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins
keywords: anemia; hemoglobin; outcomes; valve surgery