Preoperative anaemia and outcome after elective cardiac surgery: a Dutch national registry analysis

Yannick J J M Hazen; Peter G Noordzij; Bastiaan M Gerritse; Thierry V Scohy; Saskia Houterman; Sander Bramer; Remco R Berendsen; R Arthur Bouwman; Susanne Eberl; Johannes S E Haenen; Jan Hofland; Maarten Ter Horst; Marieke F Kingma; Jan Van Klarenbosch; Toni Klok; Marcel P J De Korte; Joost M A A Van Der Maaten; Alexander J Spanjersberg; Nicobert E Wietsma; Nardo J M van der Meer; Thijs C D Rettig; Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration; Patrique Segers

doi:10.1016/j.bja.2021.12.016

Preoperative anaemia and outcome after elective cardiac surgery: a Dutch national registry analysis

Yannick J J M Hazen, Peter G Noordzij, Bastiaan M Gerritse, Thierry V Scohy, Saskia Houterman, Sander Bramer, Remco R Berendsen, R Arthur Bouwman, Susanne Eberl, Johannes S E Haenen, Jan Hofland, Maarten Ter Horst, Marieke F Kingma, Jan Van Klarenbosch, Toni Klok, Marcel P J De Korte, Joost M A A Van Der Maaten, Alexander J Spanjersberg, Nicobert E Wietsma, Nardo J M van der MeerThijs C D Rettig^*, Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration, Patrique Segers

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Previous studies have shown that preoperative anaemia in patients undergoing cardiac surgery is associated with adverse outcomes. However, most of these studies were retrospective, had a relatively small sample size, and were from a single centre. The aim of this study was to analyse the relationship between the severity of preoperative anaemia and short- and long-term mortality and morbidity in a large multicentre national cohort of patients undergoing cardiac surgery.

METHODS: A nationwide, prospective, multicentre registry (Netherlands Heart Registration) of patients undergoing elective cardiac surgery between January 2013 and January 2019 was used for this observational study. Anaemia was defined according to the WHO criteria, and the main study endpoint was 120-day mortality. The association was investigated using multivariable logistic regression analysis.

RESULTS: In total, 35 484 patients were studied, of whom 6802 (19.2%) were anaemic. Preoperative anaemia was associated with an increased risk of 120-day mortality (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI]: 1.4-1.9; P<0.001). The risk of 120-day mortality increased with anaemia severity (mild anaemia aOR 1.6; 95% CI: 1.3-1.9; P<0.001; and moderate-to-severe anaemia aOR 1.8; 95% CI: 1.4-2.4; P<0.001). Preoperative anaemia was associated with red blood cell transfusion and postoperative morbidity, the causes of which included renal failure, pneumonia, and myocardial infarction.

CONCLUSIONS: Preoperative anaemia was associated with mortality and morbidity after cardiac surgery. The risk of adverse outcomes increased with anaemia severity. Preoperative anaemia is a potential target for treatment to improve postoperative outcomes.

Original language	English
Pages (from-to)	636-643
Number of pages	8
Journal	British Journal of Anaesthesia
Volume	128
Issue number	4
Early online date	11 Jan 2022
DOIs	https://doi.org/10.1016/j.bja.2021.12.016
Publication status	Published - Apr 2022

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Hazen, Y. J. J. M., Noordzij, P. G., Gerritse, B. M., Scohy, T. V., Houterman, S., Bramer, S., Berendsen, R. R., Bouwman, R. A., Eberl, S., Haenen, J. S. E., Hofland, J., Ter Horst, M., Kingma, M. F., Van Klarenbosch, J., Klok, T., De Korte, M. P. J., Van Der Maaten, J. M. A. A., Spanjersberg, A. J., Wietsma, N. E., ... Segers, P. (2022). Preoperative anaemia and outcome after elective cardiac surgery: a Dutch national registry analysis. British Journal of Anaesthesia, 128(4), 636-643. https://doi.org/10.1016/j.bja.2021.12.016

@article{23a1ff7fe85449e0836bb05d920ab165,

title = "Preoperative anaemia and outcome after elective cardiac surgery: a Dutch national registry analysis",

abstract = "BACKGROUND: Previous studies have shown that preoperative anaemia in patients undergoing cardiac surgery is associated with adverse outcomes. However, most of these studies were retrospective, had a relatively small sample size, and were from a single centre. The aim of this study was to analyse the relationship between the severity of preoperative anaemia and short- and long-term mortality and morbidity in a large multicentre national cohort of patients undergoing cardiac surgery.METHODS: A nationwide, prospective, multicentre registry (Netherlands Heart Registration) of patients undergoing elective cardiac surgery between January 2013 and January 2019 was used for this observational study. Anaemia was defined according to the WHO criteria, and the main study endpoint was 120-day mortality. The association was investigated using multivariable logistic regression analysis.RESULTS: In total, 35 484 patients were studied, of whom 6802 (19.2%) were anaemic. Preoperative anaemia was associated with an increased risk of 120-day mortality (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI]: 1.4-1.9; P<0.001). The risk of 120-day mortality increased with anaemia severity (mild anaemia aOR 1.6; 95% CI: 1.3-1.9; P<0.001; and moderate-to-severe anaemia aOR 1.8; 95% CI: 1.4-2.4; P<0.001). Preoperative anaemia was associated with red blood cell transfusion and postoperative morbidity, the causes of which included renal failure, pneumonia, and myocardial infarction.CONCLUSIONS: Preoperative anaemia was associated with mortality and morbidity after cardiac surgery. The risk of adverse outcomes increased with anaemia severity. Preoperative anaemia is a potential target for treatment to improve postoperative outcomes.",

author = "Hazen, {Yannick J J M} and Noordzij, {Peter G} and Gerritse, {Bastiaan M} and Scohy, {Thierry V} and Saskia Houterman and Sander Bramer and Berendsen, {Remco R} and Bouwman, {R Arthur} and Susanne Eberl and Haenen, {Johannes S E} and Jan Hofland and {Ter Horst}, Maarten and Kingma, {Marieke F} and {Van Klarenbosch}, Jan and Toni Klok and {De Korte}, {Marcel P J} and {Van Der Maaten}, {Joost M A A} and Spanjersberg, {Alexander J} and Wietsma, {Nicobert E} and {van der Meer}, {Nardo J M} and Rettig, {Thijs C D} and {Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration} and Patrique Segers",

year = "2022",

month = apr,

doi = "10.1016/j.bja.2021.12.016",

language = "English",

volume = "128",

pages = "636--643",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "ELSEVIER SCI LTD",

number = "4",

}

Hazen, YJJM, Noordzij, PG, Gerritse, BM, Scohy, TV, Houterman, S, Bramer, S, Berendsen, RR, Bouwman, RA, Eberl, S, Haenen, JSE, Hofland, J, Ter Horst, M, Kingma, MF, Van Klarenbosch, J, Klok, T, De Korte, MPJ, Van Der Maaten, JMAA, Spanjersberg, AJ, Wietsma, NE, van der Meer, NJM, Rettig, TCD, Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration & Segers, P 2022, 'Preoperative anaemia and outcome after elective cardiac surgery: a Dutch national registry analysis', British Journal of Anaesthesia, vol. 128, no. 4, pp. 636-643. https://doi.org/10.1016/j.bja.2021.12.016

TY - JOUR

T1 - Preoperative anaemia and outcome after elective cardiac surgery

T2 - a Dutch national registry analysis

AU - Hazen, Yannick J J M

AU - Noordzij, Peter G

AU - Gerritse, Bastiaan M

AU - Scohy, Thierry V

AU - Houterman, Saskia

AU - Bramer, Sander

AU - Berendsen, Remco R

AU - Bouwman, R Arthur

AU - Eberl, Susanne

AU - Haenen, Johannes S E

AU - Hofland, Jan

AU - Ter Horst, Maarten

AU - Kingma, Marieke F

AU - Van Klarenbosch, Jan

AU - Klok, Toni

AU - De Korte, Marcel P J

AU - Van Der Maaten, Joost M A A

AU - Spanjersberg, Alexander J

AU - Wietsma, Nicobert E

AU - van der Meer, Nardo J M

AU - Rettig, Thijs C D

AU - Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration

AU - Segers, Patrique

PY - 2022/4

Y1 - 2022/4

N2 - BACKGROUND: Previous studies have shown that preoperative anaemia in patients undergoing cardiac surgery is associated with adverse outcomes. However, most of these studies were retrospective, had a relatively small sample size, and were from a single centre. The aim of this study was to analyse the relationship between the severity of preoperative anaemia and short- and long-term mortality and morbidity in a large multicentre national cohort of patients undergoing cardiac surgery.METHODS: A nationwide, prospective, multicentre registry (Netherlands Heart Registration) of patients undergoing elective cardiac surgery between January 2013 and January 2019 was used for this observational study. Anaemia was defined according to the WHO criteria, and the main study endpoint was 120-day mortality. The association was investigated using multivariable logistic regression analysis.RESULTS: In total, 35 484 patients were studied, of whom 6802 (19.2%) were anaemic. Preoperative anaemia was associated with an increased risk of 120-day mortality (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI]: 1.4-1.9; P<0.001). The risk of 120-day mortality increased with anaemia severity (mild anaemia aOR 1.6; 95% CI: 1.3-1.9; P<0.001; and moderate-to-severe anaemia aOR 1.8; 95% CI: 1.4-2.4; P<0.001). Preoperative anaemia was associated with red blood cell transfusion and postoperative morbidity, the causes of which included renal failure, pneumonia, and myocardial infarction.CONCLUSIONS: Preoperative anaemia was associated with mortality and morbidity after cardiac surgery. The risk of adverse outcomes increased with anaemia severity. Preoperative anaemia is a potential target for treatment to improve postoperative outcomes.

AB - BACKGROUND: Previous studies have shown that preoperative anaemia in patients undergoing cardiac surgery is associated with adverse outcomes. However, most of these studies were retrospective, had a relatively small sample size, and were from a single centre. The aim of this study was to analyse the relationship between the severity of preoperative anaemia and short- and long-term mortality and morbidity in a large multicentre national cohort of patients undergoing cardiac surgery.METHODS: A nationwide, prospective, multicentre registry (Netherlands Heart Registration) of patients undergoing elective cardiac surgery between January 2013 and January 2019 was used for this observational study. Anaemia was defined according to the WHO criteria, and the main study endpoint was 120-day mortality. The association was investigated using multivariable logistic regression analysis.RESULTS: In total, 35 484 patients were studied, of whom 6802 (19.2%) were anaemic. Preoperative anaemia was associated with an increased risk of 120-day mortality (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI]: 1.4-1.9; P<0.001). The risk of 120-day mortality increased with anaemia severity (mild anaemia aOR 1.6; 95% CI: 1.3-1.9; P<0.001; and moderate-to-severe anaemia aOR 1.8; 95% CI: 1.4-2.4; P<0.001). Preoperative anaemia was associated with red blood cell transfusion and postoperative morbidity, the causes of which included renal failure, pneumonia, and myocardial infarction.CONCLUSIONS: Preoperative anaemia was associated with mortality and morbidity after cardiac surgery. The risk of adverse outcomes increased with anaemia severity. Preoperative anaemia is a potential target for treatment to improve postoperative outcomes.

U2 - 10.1016/j.bja.2021.12.016

DO - 10.1016/j.bja.2021.12.016

M3 - Article

C2 - 35031105

SN - 0007-0912

VL - 128

SP - 636

EP - 643

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 4

ER -

Preoperative anaemia and outcome after elective cardiac surgery: a Dutch national registry analysis

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