학술논문
Analysis of Anemia, Transfusions, and CABG Outcomes in The Society of Thoracic Surgeons National Database.
Document Type
Academic Journal
Author
Hosseini M; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.; Griffeth EM; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.; Schaff HV; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.; Klompas AM; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.; Warner MA; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.; Stulak JM; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.; Dearani JA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.; Lee AT; Department of Quantitative Health Sciences; Mayo Clinic, Rochester, Minnesota.; Lahr BD; Department of Quantitative Health Sciences; Mayo Clinic, Rochester, Minnesota.; Crestanello JA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: crestanello.juan@mayo.edu.
Source
Publisher: Elsevier Country of Publication: Netherlands NLM ID: 15030100R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-6259 (Electronic) Linking ISSN: 00034975 NLM ISO Abbreviation: Ann Thorac Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: This study characterized the association of preoperative anemia and intraoperative red blood cell (RBC) transfusion on outcomes of elective coronary artery bypass grafting (CABG).
Methods: Data from 53,856 patients who underwent CABG included in The Society of Thoracic Surgeons (STS) Adult Cardiac Database in 2019 were used. The primary outcome was operative mortality. Secondary outcomes were postoperative complications. The association of anemia with outcomes was analyzed with multivariable regression models. The influence of intraoperative RBC transfusion on the effect of preoperative anemia on outcomes was studied using mediation analysis.
Results: Anemia was present in 25% of patients. Anemic patients had a higher STS Predicted Risk of Operative Mortality (1.2% vs 0.7%; P < .001). Anemia was associated with operative mortality (odds ratio [OR], 1.27; 99.5% CI, 1.00-1.61; P = .047), postoperative RBC transfusion (OR, 2.28; 99.5% CI, 2.12-2.44; P < .001), dialysis (OR, 1.58; 99.5% CI, 1.19-2.11; P < .001), and prolonged intensive care unit and hospital length of stay. Intraoperative RBC transfusion largely mediated the effects of anemia on mortality (76%), intensive care unit stay (99%), and hospital stay, but it only partially mediated the association with dialysis (34.9%).
Conclusions: Preoperative anemia is common in patients who undergo CABG and is associated with increased postoperative risks of mortality, complications, and RBC transfusion. However, most of the effect of anemia on mortality is mediated through intraoperative RBC transfusion.
(Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Methods: Data from 53,856 patients who underwent CABG included in The Society of Thoracic Surgeons (STS) Adult Cardiac Database in 2019 were used. The primary outcome was operative mortality. Secondary outcomes were postoperative complications. The association of anemia with outcomes was analyzed with multivariable regression models. The influence of intraoperative RBC transfusion on the effect of preoperative anemia on outcomes was studied using mediation analysis.
Results: Anemia was present in 25% of patients. Anemic patients had a higher STS Predicted Risk of Operative Mortality (1.2% vs 0.7%; P < .001). Anemia was associated with operative mortality (odds ratio [OR], 1.27; 99.5% CI, 1.00-1.61; P = .047), postoperative RBC transfusion (OR, 2.28; 99.5% CI, 2.12-2.44; P < .001), dialysis (OR, 1.58; 99.5% CI, 1.19-2.11; P < .001), and prolonged intensive care unit and hospital length of stay. Intraoperative RBC transfusion largely mediated the effects of anemia on mortality (76%), intensive care unit stay (99%), and hospital stay, but it only partially mediated the association with dialysis (34.9%).
Conclusions: Preoperative anemia is common in patients who undergo CABG and is associated with increased postoperative risks of mortality, complications, and RBC transfusion. However, most of the effect of anemia on mortality is mediated through intraoperative RBC transfusion.
(Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)