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Lau MPXL, Low CJW, Ling RR, Liu NSH, Tan CS, Ti LK, Kofidis T, MacLaren G, Ramanathan K. Preoperative anemia and anemia treatment in cardiac surgery: a systematic review and meta-analysis. Can J Anaesth 2024; 71:127-142. [PMID: 37932652 DOI: 10.1007/s12630-023-02620-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/07/2023] [Accepted: 07/23/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE We aimed to conduct a systematic review and meta-analysis to assess the effects of anemia and anemia severity on patient outcomes in cardiac surgery and determine whether preoperative treatments confer postoperative benefit. SOURCE We searched four international databases for observational and randomized studies published until 1 October 2022. Study quality was assessed via Newcastle-Ottawa scores and the Cochrane Risk-of-Bias 2 tool and certainty of evidence was rated with the Grading of Recommendations, Assessment, Development and Evaluations approach. We conducted random-effects meta-analyses for our primary outcome of mortality, for secondary outcomes including length of stay (LOS) in the hospital and intensive care unit, and for postsurgical complications. As part of a secondary analysis, we analyzed short-term preoperative anemia treatments and conducted trial sequential analysis of randomized trials to assess the efficacy of these treatment programs. PRINCIPAL FINDINGS We included 35 studies (159,025 patients) in our primary meta-analysis. Preoperative anemia was associated with increased mortality (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.2 to 2.9; P < 0.001, high certainty). Study-level meta-regression revealed lower hemoglobin levels and studies with lower proportions of male patients to be associated with increased risk of mortality. Preoperative anemia was also associated with an increase in LOS and postsurgical complications. Our secondary analysis (seven studies, 1,012 patients) revealed short-term preoperative anemia treatments did not significantly reduce mortality (OR, 1.1; 95% CI, 0.65 to 1.9; P = 0.69). Trial sequential analysis suggested that there was insufficient evidence to conclude if treatment programs yield any benefit or harm. CONCLUSIONS Preoperative anemia is associated with mortality and morbidity after cardiac surgery. More research is warranted to test the efficacy of current anemia treatment programs. STUDY REGISTRATION PROSPERO (CRD42022319431); first submitted 17 April 2023.
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Affiliation(s)
- Michele P X L Lau
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Christopher J W Low
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Nigel S H Liu
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Chuen Seng Tan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Lian Kah Ti
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Department of Anaesthesia, National University Hospital, National University Health System, Singapore, Singapore
| | - Theo Kofidis
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Heart Centre, National University Hospital, National University Health System, Singapore, Singapore
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, National University Health System, Singapore, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, National University Health System, Singapore, Singapore.
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Gelebo KG, Neme D, Destaw B, Aweke Z, Kasa SM. The effect of preoperative anemia on perioperative outcomes among patients undergoing emergency surgery: A multicenter prospective cohort study. Heliyon 2023; 9:e17804. [PMID: 37483819 PMCID: PMC10359863 DOI: 10.1016/j.heliyon.2023.e17804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Preoperative anemia is a common finding among surgical patients. It is associated with an increased risk of perioperative morbidity and mortality. Outcomes among emergency surgical patients are not established. This study aimed to assess the effect of preoperative anemia on perioperative outcomes among patients undergoing emergency surgery in selected Southern Ethiopia governmental teaching hospitals, Southern Ethiopia, 2022. Method A multicenter prospective cohort study was conducted. Data were collected at selected hospitals, after obtaining ethical approval from the institutional review board. Descriptive statistics, cross-tabulation, and multivariable binary logistic regression analysis were performed. A P-value less than 0.05 were taken as statistically significant. Result A total of 200 patients who underwent emergency surgery were grouped into the anemia group (100 patients) while the rest were in the non-anemia group. There was no statistically significant difference between the groups regarding socio-demographic and intraoperative patient characteristics. Based on multivariate logistic regression, anemia group had a significant risk of perioperative transfusion requirement (Relative Risk (RR) = 4.030, p < 0.001), developing postoperative complications (RR = 1.868, p = 0.017), occurring in-hospital mortality (RR = 5.763, p = 0.045), prolong the length of hospital stay (RR = 4.028, p < 0.001), and requiring postoperative intensive care unit admission (RR = 6.332, p = 0.003) compared with non-anemia groups. Conclusion Preoperative anemia was associated with a higher rate of perioperative transfusion requirements, along with increased postoperative complication, increased in-hospital mortality, increased Intensive Critical Care Unit admission rate, and prolonged length of hospital stay. We recommend adequate preoperative assessment and correction of hemoglobin concentrations to normal values to improve surgical outcomes and reduce complications.
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Affiliation(s)
- Kanbiro Gedeno Gelebo
- Department of Anesthesia, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Derartu Neme
- Department of Anesthesia, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Belete Destaw
- Department of Anesthesia, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Zemedu Aweke
- Department of Anesthesia, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Simeneh Mola Kasa
- Department of Anesthesia, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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Yagur Y, Ribak R, Ben Ezry E, Cohen I, Or Madar L, Kovo M, Biron-Shental T. Do maternal albumin levels affect post-operative complications after cesarean delivery? BMC Pregnancy Childbirth 2022; 22:909. [PMID: 36474218 PMCID: PMC9727901 DOI: 10.1186/s12884-022-05215-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study explored the correlation between maternal serum albumin levels prior to elective cesarean delivery (CD) and postoperative complications. METHODS This retrospective cohort study included women admitted for elective CD at term to our tertiary referral center, during the years 2016-2018. Blood samples were collected during the preoperative admission. Information collected included maternal demographics, pregnancy and postoperative complications. Data between patients with preoperative serum albumin levels < 3.3 g/dL or ≥ 3.3 g/dL were compared. RESULTS Among 796 women admitted for an elective CD, 537 met the inclusion criteria. There were 250 (46.6%) women in the low albumin level group (< 3.3 g/dL) and 287 (53.4%) with serum albumin level ≥ 3.3 g/dL. Patients with serum albumin ≥ 3.3 g/dL had increased rates of surgical site infection (SSI) (5.6% vs. 1.6% respectively; p = 0.02), need for antibiotics during the post-partum period (10.8% vs 3.2%, respectively; p = 0.001), surgical intervention (2.1% vs. 0%, respectively; p = 0.03) and higher rate of rehospitalization (5.2% vs. 0.4%, respectively; p = 0.001). Multivariant analysis showed that albumin level ≥ 3.3 g/dL was independently associated with composite postoperative adverse maternal outcome. CONCLUSIONS High serum albumin levels among women undergoing CD, might be associated with abnormal postoperative outcomes. Larger prospective studies, with a heterogenous population are needed to validate these observations.
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Affiliation(s)
- Yael Yagur
- grid.12136.370000 0004 1937 0546Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Ribak
- grid.12136.370000 0004 1937 0546Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emili Ben Ezry
- grid.12136.370000 0004 1937 0546Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Cohen
- grid.12136.370000 0004 1937 0546Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Libby Or Madar
- grid.12136.370000 0004 1937 0546Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- grid.12136.370000 0004 1937 0546Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- grid.12136.370000 0004 1937 0546Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Perelman SI, Shander A, Mabry C, Ferraris VA. Preoperative anemia management in the coronavirus disease (COVID-19) era. JTCVS OPEN 2021; 5:85-94. [PMID: 34173552 PMCID: PMC7836783 DOI: 10.1016/j.xjon.2020.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Seth I. Perelman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Aryeh Shander
- TeamHealth Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Health, Englewood, NJ
| | - Christian Mabry
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Victor A. Ferraris
- Department of Cardiothoracic Surgery, Lexington VA Medical Center, University of Kentucky, Lexington, Ky
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Kramer RS, Kelting T. Commentary: Goal-directed or flow-directed perfusion? J Thorac Cardiovasc Surg 2020; 164:1008-1009. [PMID: 33454092 DOI: 10.1016/j.jtcvs.2020.12.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Robert S Kramer
- Division of Cardiovascular Surgery, Department of Cardiovascular Services, Maine Medical Center, Portland, Maine.
| | - Tyler Kelting
- Division of Cardiovascular Surgery, Department of Cardiovascular Services, Maine Medical Center, Portland, Maine
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Meybohm P, Westphal S, Ravn HB, Ranucci M, Agarwal S, Choorapoikayil S, Spahn DR, Ahmed AB, Froessler B, Zacharowski K. Perioperative Anemia Management as Part of PBM in Cardiac Surgery – A Narrative Updated Review. J Cardiothorac Vasc Anesth 2020; 34:1060-1073. [DOI: 10.1053/j.jvca.2019.06.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/18/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022]
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Padmanabhan H, Siau K, Curtis J, Ng A, Menon S, Luckraz H, Brookes MJ. Preoperative Anemia and Outcomes in Cardiovascular Surgery: Systematic Review and Meta-Analysis. Ann Thorac Surg 2019; 108:1840-1848. [DOI: 10.1016/j.athoracsur.2019.04.108] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 03/06/2019] [Accepted: 04/29/2019] [Indexed: 01/11/2023]
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Padmanabhan H, Brookes MJ, Nevill AM, Luckraz H. Association Between Anemia and Blood Transfusion With Long-term Mortality After Cardiac Surgery. Ann Thorac Surg 2019; 108:687-692. [DOI: 10.1016/j.athoracsur.2019.04.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 12/28/2022]
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Gómez-Ramirez S, Jericó C, Muñoz M. Perioperative anemia: Prevalence, consequences and pathophysiology. Transfus Apher Sci 2019; 58:369-374. [DOI: 10.1016/j.transci.2019.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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David O, Sinha R, Robinson K, Cardone D. The Prevalence of Anaemia, Hypochromia and Microcytosis in Preoperative Cardiac Surgical Patients. Anaesth Intensive Care 2019; 41:316-21. [DOI: 10.1177/0310057x1304100307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- O. David
- Royal Adelaide Hospital, Department of Anaesthesia, Adelaide, South Australia, Australia
| | - R. Sinha
- Royal Adelaide Hospital, Department of Anaesthesia, Adelaide, South Australia, Australia
- Faculty of Health Sciences, Flinders University
| | - K. Robinson
- Royal Adelaide Hospital, Department of Anaesthesia, Adelaide, South Australia, Australia
- Australian Red Cross Blood Service and Clinical Lead, BloodSafe Program, SA Health
| | - D. Cardone
- Royal Adelaide Hospital, Department of Anaesthesia, Adelaide, South Australia, Australia
- Department of Anaesthesia, Royal Adelaide Hospital and Senior Clinical Lecturer, Faculty of Acute Care Medicine, University of Adelaide
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11
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Nelson M, Green J, Spiess B, Kasirajan V, Nicolato P, Liu H, Meshkin RS. Measurement of Blood Loss in Cardiac Surgery: Still Too Much. Ann Thorac Surg 2018; 105:1176-1181. [PMID: 29506777 DOI: 10.1016/j.athoracsur.2017.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cardiac surgery is associated with a significant decrease in hematocrit. It is unclear whether that occurs from hemodilution, loss of red cells, or both. Hematocrit is a major determinant of transfusion decisions although transfusion is associated with increased morbidity and mortality. Physicians must determine whether this anemia is the result of hemodilution or red blood cell loss as the former would be treated with packed red blood cell transfusions and the latter by diuresis. We hypothesize that the decrease in hematocrit observed in cardiac surgery is due to hemodilution. METHODS Blood volume (BV), plasma volume (PV), and red blood cell volume (RBCV) were measured in 54 patients undergoing coronary artery bypass graft surgery, valve surgery, or coronary artery bypass graft/valve surgery. Measurements were made preoperatively, immediately postoperatively, and 2 hours after surgery utilizing a dilution tracer method and hematocrit measurements. RESULTS Preoperative average BV was 6,094 mL (SD 1,904 mL), RBCV was 2,024 mL (SD 720 mL), and PV was 4,070 mL (SD 1,339 mL). Postoperative average BV was 4,834 mL (SD 1,432 mL), RBCV 1,226 mL (SD 527 mL), and PV 3,607 mL (SD 993 mL). Blood volume decreased 18% (p < 0.0001), RBCV decreased 38% (p < 0.001), and PV decreased 8% (p < 0.012). There were no significant changes between postoperative values and those 2 hours later in the cardiac surgery intensive care unit. CONCLUSIONS Decreases in hematocrit observed in cardiac surgery patients are due to significant red blood cell losses and not to hemodilution. Red blood cell losses averaged 38%. Plasma volume also decreased.
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Affiliation(s)
- Mark Nelson
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Virginia Commonwealth University, Richmond, Virginia.
| | - Jeffrey Green
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
| | - Bruce Spiess
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
| | - Vigneshwar Kasirajan
- Department of Surgery, Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Patricia Nicolato
- Department of Surgery, Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Hangcheng Liu
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Ryan S Meshkin
- Department of Biology, Virginia Commonwealth University, Richmond, Virginia
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Preoperative Anaemia and Associated Postoperative Outcomes in Noncardiac Surgery Patients in Central Region of Ghana. Anesthesiol Res Pract 2017; 2017:7410960. [PMID: 29375620 PMCID: PMC5742513 DOI: 10.1155/2017/7410960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/30/2017] [Accepted: 11/14/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction Several studies suggest that preoperative anaemia (PA) is associated with adverse postoperative outcomes, but little is known about these outcomes in the Central Region of Ghana. This study aims to determine the prevalence of PA among noncardiac surgical patients and its implications for their postoperative outcomes. Methods This study was designed as an observational study; data including demographics and clinical and laboratory results were collected from the patients' records and through interviews. Results A total of 893 inpatient surgical cases undergoing elective and emergency operations, aged 15 years and above with mean age of 44.2 ± 17.0 yrs, were enrolled. The prevalence of PA was 54.3%, mostly microcytic with or without hypochromia (57.2%). The prevalence was higher in females than males (p ≤ 0.001). Preoperative anaemia was significantly associated with prolonged length of hospital stay (OR: 2.12 (95% CI: 1.49–3.10)). Allogeneic blood transfusion significantly prolonged the length of hospital stay (OR 4.48 (95% CI: 2.67–7.51)). 15.5% of the anaemic patients received oral iron supplements compared to 2.2% of nonanaemic patients (p ≤ 0.001). Conclusion Preoperative anaemia is common among noncardiac surgical patients. It is independently and significantly associated with prolonged hospital stay leading to the use of increased healthcare resources. It is also the main predictor for perioperative allogeneic blood transfusions and the use of haematinics.
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Abstract
Heart surgery patients have a high prevalence of anemia. Its etiology is multifactorial, and iron deficiency is one of the most common correctable causes. Anemia is an independent risk factor for postsurgical morbidity and mortality. It also predisposes patients to a greater need for transfusions, which increases the associated complications and the use of resources. The etiological diagnosis of anemia is no different from that of other surgical procedures, but the time available for correcting it before surgery is shorter. Studies have been conducted on therapeutic regimens with iron deficiency replenishment with total dose and erythropoiesis-stimulating agents, which enable the rapid correction of anemia and reduce transfusion requirements. There is considerable variability in terms of dosage, adverse effects, administration time and routes, drug combinations and results. New studies are needed to investigate the most ideal regimens for correcting anemia in these patients.
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Affiliation(s)
- G J Yanes Vidal
- Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Hogervorst EK, Rosseel PM, van de Watering LM, Brand A, Bentala M, van der Bom JG, van der Meer NJ. Intraoperative Anemia and Single Red Blood Cell Transfusion During Cardiac Surgery: An Assessment of Postoperative Outcome Including Patients Refusing Blood Transfusion. J Cardiothorac Vasc Anesth 2016; 30:363-72. [DOI: 10.1053/j.jvca.2015.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Indexed: 12/28/2022]
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Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg 2015; 102:1314-24. [PMID: 26349842 DOI: 10.1002/bjs.9861] [Citation(s) in RCA: 309] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/26/2015] [Accepted: 04/20/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Numerous published studies have explored associations between anaemia and adverse outcomes after surgery. However, there are no evidence syntheses describing the impact of preoperative anaemia on postoperative outcomes. METHODS A systematic review and meta-analysis of observational studies exploring associations between preoperative anaemia and postoperative outcomes was performed. Studies investigating trauma, burns, transplant, paediatric and obstetric populations were excluded. The primary outcome was 30-day or in-hospital mortality. Secondary outcomes were acute kidney injury, stroke and myocardial infarction. Predefined analyses were performed for the cardiac and non-cardiac surgery subgroups. A post hoc analysis was undertaken to evaluate the relationship between anaemia and infection. Data are presented as odds ratios (ORs) with 95 per cent c.i. RESULTS From 8973 records, 24 eligible studies including 949 445 patients were identified. Some 371 594 patients (39·1 per cent) were anaemic. Anaemia was associated with increased mortality (OR 2·90, 2·30 to 3·68; I(2) = 97 per cent; P < 0·001), acute kidney injury (OR 3·75, 2·95 to 4·76; I(2) = 60 per cent; P < 0·001) and infection (OR 1·93, 1·17 to 3·18; I(2) = 99 per cent; P = 0·01). Among cardiac surgical patients, anaemia was associated with stroke (OR 1·28, 1·06 to 1·55; I(2) = 0 per cent; P = 0·009) but not myocardial infarction (OR 1·11, 0·68 to 1·82; I(2) = 13 per cent; P = 0·67). Anaemia was associated with an increased incidence of red cell transfusion (OR 5·04, 4·12 to 6·17; I(2) = 96 per cent; P < 0·001). Similar findings were observed in the cardiac and non-cardiac subgroups. CONCLUSION Preoperative anaemia is associated with poor outcomes after surgery, although heterogeneity between studies was significant. It remains unclear whether anaemia is an independent risk factor for poor outcome or simply a marker of underlying chronic disease. However, red cell transfusion is much more frequent amongst anaemic patients.
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Affiliation(s)
- A J Fowler
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - T Ahmad
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M K Phull
- Departments of Anaesthesia, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S Allard
- Departments of Haematology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M A Gillies
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R M Pearse
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Cheungpasitporn W, Thongprayoon C, Chiasakul T, Korpaisarn S, Erickson SB. Renin-angiotensin system inhibitors linked to anemia: a systematic review and meta-analysis. QJM 2015; 108:879-84. [PMID: 25697787 DOI: 10.1093/qjmed/hcv049] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The objective of this meta-analysis was to evaluate the risk of anemia in patients who received renin-angiotensin system (RAS) inhibitors. METHODS A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception through November, 2014. Studies that reported relative risks, odd ratios or hazard ratios comparing the anemia risk in patients who received angiotensin-converting-enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) vs. those who did not were included. We performed the prespecified sensitivity analysis including only only studies with confounder adjusted analysis. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS Seven studies (2 cohort and 5 cross-sectional studies) with 29,061 patients were included in the analysis to assess the risk of anemia and the RAS inhibitors use. The pooled RR of anemia in patients receiving ACEIs was 1.56 (95% CI, 1.40-1.73, I(2) = 17%). When meta-analysis was limited only to studies with confounder adjusted analysis, the pooled RR of anemia in patients using ACEIs was 1.57 (95% CI, 1.43-1.73, I(2) = 0%) The pooled RR of anemia in patients receiving ARBs was 1.60 (95% CI, 1.27-2.00, I(2) = 39%). The meta-analysis of studies with confounder adjusted analysis demonstrated the pooled RR of anemia in patients using ARBs of 1.59 (95% CI, 1.38-1.83, I(2) = 0%). CONCLUSIONS Our meta-analysis demonstrates an association between anemia and the use of RAS inhibitors. Hematological parameters should be monitored in patients treated with RAS inhibitors.
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Affiliation(s)
- W Cheungpasitporn
- From the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA,
| | - C Thongprayoon
- From the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - T Chiasakul
- Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand and
| | - S Korpaisarn
- Department of Internal Medicine, MetroWest Medical Center, Framingham, MA, USA
| | - S B Erickson
- From the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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Hogervorst E, Rosseel P, van der Bom J, Bentala M, Brand A, van der Meer N, van de Watering L. Tolerance of intraoperative hemoglobin decrease during cardiac surgery. Transfusion 2014; 54:2696-704. [DOI: 10.1111/trf.12654] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/18/2014] [Accepted: 02/18/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Esther Hogervorst
- Center for Clinical Transfusion Reseach; Sanquin/LUMC; Leiden the Netherlands
| | | | - Johanna van der Bom
- Center for Clinical Transfusion Reseach; Sanquin/LUMC; Leiden the Netherlands
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden the Netherlands
| | | | - Anneke Brand
- Center for Clinical Transfusion Reseach; Sanquin/LUMC; Leiden the Netherlands
| | | | - Leo van de Watering
- Center for Clinical Transfusion Reseach; Sanquin/LUMC; Leiden the Netherlands
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Elmistekawy E, Boodhwani M. Reply to Tao et al. Eur J Cardiothorac Surg 2013; 44:1157. [PMID: 23674654 DOI: 10.1093/ejcts/ezt273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elsayed Elmistekawy
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Elmistekawy E, Rubens F, Hudson C, McDonald B, Ruel M, Lam K, Mesana TG, Boodhwani M. Preoperative anaemia is a risk factor for mortality and morbidity following aortic valve surgery. Eur J Cardiothorac Surg 2013; 44:1051-5; discussion 1055-6. [DOI: 10.1093/ejcts/ezt143] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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