Impact of preoperative anemia on cardiac surgery in octogenarians

• Published in: Interactive cardiovascular and thoracic surgery Vol. 10; no. 2; pp. 249 - 255
• Main Authors: Carrascal, Yolanda, Maroto, Laura, Rey, Juvenal, Arevalo, Adolfo, Arroyo, Jaime, Echevarria, Jose R, Arce, Nuria, Fulquet, Enrique
• Format: Journal Article
• Language: English
• Published: England Eur Assoc Cardio Surg 01.02.2010; European Association for Cardio-Thoracic Surgery
• Subjects: Age Factors; Aged, 80 and over; Anemia - blood; Anemia - complications; Anemia - mortality; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Creatinine - blood; Elective Surgical Procedures; Erythrocyte Transfusion; Female; Hematocrit; Hemoglobins - metabolism; Hospital Mortality; Humans; Kaplan-Meier Estimate; Length of Stay; Logistic Models; Male; Odds Ratio; Peripheral Vascular Diseases - complications; Proportional Hazards Models; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Anemia; Octogenarians; Cardiac surgery
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2009.220160

Department of Cardiac Surgery, Instituto de Ciencias del Corazón (ICICOR), University Hospital, Avda. Ramón y Cajal, 3, 47005 Valladolid, Spain *Corresponding author. Tel.: +34 983 420 000 (Ext. 191); fax: +34 983 255 305. E-mail address : ycarrascal{at}hotmail.com (Y. Carrascal). Objectives: Preoperative anemia has been related with adverse outcomes in elective valve replacement and CABG surgery. Impact of preoperative anemia on outcome in octogenarians submitted to cardiopulmonary bypass (CPB) has not yet been precisely described. Methods: We analyzed association between preoperative hemoglobin level, minimum intraoperative and immediate postoperative hematocrit (HCT), and other co-morbidities and occurrence of adverse outcomes in 227 octogenarians who underwent cardiac surgery. Results: Frequency of preoperative anemia was 41.9% (40.4% in male and 43.5% in female patients). Postoperative mortality was 13.2% (9% in non-anemic patients vs. 18.9% in anemic). 44.5% of patients suffered at least one postoperative adverse outcome (43.1% non-anemic vs. 46.3% anemic). In multivariate analysis (after adjusting independent preoperative risk factors for operative mortality and EuroSCORE) preoperative creatinin level [odds ratio (OR), 2.29; 95% confidence interval (CI), 1.06–4.98; P =0.035], immediate postoperative HCT <24% (OR, 2.78; 95% CI, 1.04–7.38; P =0.039), perioperative red blood cell (RBC) transfusion (OR, 1.58; 95% CI, 1.24–2.00; P =0.0001), peripheral vascular disease (OR, 4.92; 95% CI, 1.45–16.69; P =0.012) and urgent surgery (OR, 10.57; 95% CI, 2.54–43.91; P =0.0001) were identified as independent predictors for in-hospital mortality. Conclusions: Mortality and adverse postoperative outcome increase in anemic octogenarians undergoing cardiac surgery. Although mortality is directly related to immediate postoperative anemia, adverse outcomes mainly depend on associated co-morbidities. Key Words: Octogenarians; Anemia; Cardiac surgery