Original articleAdult cardiacPreoperative Hematocrit Is a Powerful Predictor of Adverse Outcomes in Coronary Artery Bypass Graft Surgery: A Report From The Society of Thoracic Surgeons Adult Cardiac Surgery Database
Section snippets
The Society of Thoracic Surgeons Adult Cardiac Surgery Database
The STS ACSD was established in 1989 to report surgical outcomes after cardiothoracic surgical procedures [16]. Patient data are entered from sites using uniform definitions (available online at http://www.sts.org) and certified software systems. Although participation in the STS database is voluntary, data completeness is high, with overall preoperative risk factors missing in fewer than 5% of submitted cases. The STS ACSD currently includes data from more than 90% of hospitals performing
Results
We identified 182,599 patients who underwent primary isolated on-pump CABG between January 2008 and December 2009. Patient characteristics are outlined in Table 1. The median age was 65 years, 27% were women, and the mean ejection fraction was 0.513. The median preoperative HCT was 39% (interquartile range, 36% to 42%). The distribution of preoperative HCT is illustrated in Fig 1. The preoperative HCT was less than or equal to 36% in 30.1% (54,948 of 182,599) of patients and was less than 39%
Comment
The key findings of this study include the following: (1) among a contemporary national experience of more than 180,000 patients undergoing primary isolated CABG, the preoperative HCT is a powerful independent predictor of mortality, renal failure, deep sternal wound infection, and prolonged hospital stay; (2) of all the morbidity and mortality outcomes examined in this study, the preoperative HCT has the greatest and most consistent impact on the risk of renal failure; (3) similar outcomes
References (27)
- et al.
Preoperative haemoglobin concentration and mortality rate after coronary artery bypass surgery
Lancet
(2002) - et al.
Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury
J Thorac Cardiovasc Surg
(2009) - et al.
IPDACS Study. Incidence and predictors of delirium after cardiac surgery: results from The IPDACS Study
J Psychosom Res
(2010) - et al.
Hematocrit on cardiopulmonary bypass and outcome after coronary surgery in nontransfused patients
Ann Thorac Surg
(2010) - et al.
Nadir hematocrit during cardiopulmonary bypass: end-organ dysfunction and mortality
J Thorac Cardiovasc Surg
(2012) - et al.
Transfusion in coronary artery bypass grafting is associated with reduced long-term survival
Ann Thorac Surg
(2006) - et al.
The STS National Database: current changes and challenges for the new millennium. Committee to Establish a National Database in Cardiothoracic Surgery, The Society of Thoracic Surgeons
Ann Thorac Surg
(2000) - et al.
Successful linking of the Society of Thoracic Surgeons database to social security data to examine survival after cardiac operations
Ann Thorac Surg
(2011) - et al.
Regulatory and ethical considerations for linking clinical and administrative databases
Am Heart J
(2009) - et al.
Hematocrit on cardiopulmonary bypass and outcome after coronary surgery in nontransfused patients
Ann Thorac Surg
(2010)
Surgical and Clinical Outcome Research (SCORE) Group. Impact of preoperative anemia on outcome in adult cardiac surgery: a propensity-matched analysis
Ann Thorac Surg
Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury
J Thorac Cardiovasc Surg
Implications and management of anemia in cardiac surgery: current state of knowledge
J Thorac Cardiovasc Surg
Cited by (55)
Unexpected impact of preoperative anemia in low-risk isolated coronary artery bypass grafting or single-valve surgical patients: Do not overlook these patients in anemia management!
2023, Journal of Thoracic and Cardiovascular SurgeryEnhanced recovery after cardiac surgery under CPB or off-pump 2021
2022, Anesthesie et ReanimationGuidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump
2022, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :PBM in the practice of cardiac surgery reduces the need for heterologous blood transfusion with a high level of scientific evidence [223]; however, it remains uncertain whether this might reduce in-hospital mortality, postoperative morbidity and the length of hospital stay. Several “before versus after” comparative studies [223–230] have shown that implementing a PBM programme in the practice of cardiac surgery constantly reduces the need for heterologous blood transfusion but inconstantly also reduces the length of stay (with an increased further risk of readmission in cases where the haemoglobin level at discharge is lower than 8 g/dL) [227]. Such studies, the larger of which included almost 80,000 patients [223], did not find a consistent benefit in terms of in-hospital morbidity and postoperative complications (myocardial, neurological or renal).
Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)
2021, Revista Espanola de Anestesiologia y ReanimacionPreoperative intravenous iron before cardiac surgery: a prospective multicentre feasibility study
2020, British Journal of Anaesthesia
- ∗
Recipient of The Society of Thoracic Surgeons 2013 President’s Award.