Preoperative Anemia Increases risk of Renal Dysfunction after Coronary ArteryBypass Surgery
Keywords:Anemia, Cardiac Surgery, CABG, Renal Dysfunction, Stroke
AbstractINTRODUCTION: Preoperative anemia is commonly encountered in patients undergoing coronary artery bypass surgery. It is now an established fact that anemia at the time of surgery affects the outcome. However, this fact has not been taken into account in the major cardiac surgery risk stratification systems. The impact of preoperative anemia on development of postoperative renal failure is not very well established. This study is planned to evaluate this effect. AIMS & OBJECTIVE: To assess the increases risk of renal dysfunction after Coronary Artery Bypass Surgery in patients having preoperative anemia. MATERIAL AND METHODS: This is a retrospective study, data extracted from the patient record operated at our institution between Jan 2019 to Feb 2021 for isolated stable coronary artery bypass surgery. A total of 819 patients were operated, final sample size of 773 patients was selected, 185 (24%) were anemic by world health organization definition of anemia. These patients and various parameters were then compared with non-anemic patients. RESULTS: Preoperative anemia was associated with three times increased risk of developing acute kidney injury or worsening of pre-existing renal dysfunction (18.3% vs 6.4% p<0.0001). There was also a significant difference in the anemic and no-anemic groups in developing postoperative stroke (2% vs 1% p=0.008), development of new onset atrial fibrillation (36.2% vs 32.9% p=0.003) and prolonged hospital stay (53.5% vs 35.8% p<0.0001). There was however no effect on postoperative myocardial infarction *2% in each group p=0.09). CONCLUSION: Preoperative anemia is a significant contributor to development of renal dysfunction, stroke and atrial fibrillation after coronary artery bypass surgery. KEYWORDS: Anemia, cardiac surgery, CABG, renal dysfunction, stroke
Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci. 2019;1450(1):15-31. doi:10.1111/nyas.14092
Zindrou D, Taylor KM, Bagger JP: Preoperative haemoglobin concentration and mortality rate after coronary artery bypass surgery. Lancet 2002,359:1747–1748.
Karkouti K, Wijeysundera DN, Beattie S for the reducing bleeding in cardiac surgery (RBC) investigators: Risk associated with preoperative anemia in cardiac surgery. A multicenter cohort study. Circulation 2008, 117:478–484.
Van Straten AHM, Hamad MAS, Van Zundert AJ, Martens EJ, Schonberger JPAM, De Wolf AM: Preoperative hemoglobin level as predictor of survival after coronary artery bypass grafting. A comparison with the matched population. Circulation 2009, 120:118–125.
Cladellas M, Bruguera J, Comin J, Vila J, De Jaime E, Marti J, Gomez M: Is preoperative anaemia a risk marker for in-hospital mortality and morbidity after valve replacement? Eur Heart J 2006, 27:1093–1099.
Magovern JA, Sakert T, Magovern GJ, Benckart DH, Burkholder JA, Liebler GA, Magovern GJ Sr: A model that predicts morbidity and mortality after coronary artery bypass graft surgery. J Am Coll Cardiol 1996, 28:1147–1153.
Ranucci M, DiDedda U, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G, Surgical and Clinical Outcome Research (SCORE) Group: Impact of preoperative anemia on outcomes in adult cardiac surgery: a propensity-matched analysis. Ann Thorac Surg 2012, 94:1134–1142.
Bell ML, Grunwald GK, Baltz JH, McDonald GO, Bell MR, Grover FL, Shroyer AL: Does preoperative hemoglobin independently predict short-term outcomes after coronary artery bypass graft surgery? Ann Thorac Surg 2008, 86:1415–1423.
Carrascal Y, Maroto L, Rey J, Arévslo J, Echevarria JR, Arce N, Fulquet E: Impact of preoperative anemia on cardiac surgery in octogenarians. Interact Cardiovasc Thoracic Surg 2010, 10:249–255.
Kulier A, Levin J, Moser R, Rumpold-Seitlinger G, Tudor IC, Snyder-Ramos SA, Moehnle P, Mangano DT, Investigators of the Multicenter Study ofPerioperative Ischemia Research Group; Ischemia Research and EducationFoundation: Impact of preoperative anemia on outcome in patientsundergoing coronary artery bypass graft surgery. Circulation 2007,116:471–479.
Nilsson J, Ohlsson M, Thulin L, Hoglund P, Nashef SA, Brandt J: Comparison of 19 preoperative risk stratification models in open heart surgery. EurHeart J 2006, 27:867–874.
Higgins TL, Estafanous FG, Loop FD, Beck GJ, Blum JM, Paranandi L: Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score. JAMA 1992, 267:2344–2348.
Mj S, Tighiouart H, Manjunath G, MacLeod B, Griffith J, Salem D, Levey AS: Anemia as a risk factor for cardiovascular disease in the Atherosclerosis risk in communities (ARIC) study. J Am Coll Cardiol 2002, 40:27–33.
Izaks GJ, Westendorp RG, Knook DL: The definition of anemia in the older person. JAMA 1999, 281:1714–1717.
Ezekowitz JA, McAlister FA, Armstrong PW: Anemia is common in heart failure and is associated with poor outcomes: insight from a cohort of 12 065 patients with new-onset heart failure. Circulation 2003, 107:223–225.
Tng YD, Katz SD: Anemia in chronic heart failure: prevalence, etiology, clinical correlates, and treatment options. Circulation 2006, 113:2454–2461
Sabatine MS, Morrow DA, Giugliano RP, Burton PB, Murphy SA, McCabe CH, Gibson CM, Braunwald E: Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 2005, 111:2042–2049.
Younge JO, Nauta ST, Akkerhui KM, Deckers JW, Van Domburg RT: Effect of anemia on short- and long-term outcome in patients hospitalized for acute coronary syndromes. Am Heart J 2012, 109:506–510.
Wu WC, Schifftner TL, Henderson WG, Eaton CB, Poses RM, Uttley G, Sharma SC, Vezeridis M, Khuri SF, Friedmann PD: Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA 2007, 297:2481.
Karkouti K, Djaiani G, Borger MA, Beattie WS, Fedorko L, Wijeysundera D, Ivanov J, Karski J: Low hematocrit during cardiopulmonary bypass is associated with increased risk of perioperative stroke in cardiac surgery. Ann Thorac Surg 2005, 80:1381–1387.
Karkouti K, Beattie WS, Wijeysundera DN, Rao V, Chan C, Dattilo KM, Djaini G, Ivanov J, Karski J, David TE: Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 2005, 129:391–400.
Murphy GJ, Reeves B, Rogers CA, Rizvi SI, Culliford L, Angelini GD: Increased mortality, post-operative morbidity and cost following red blood cell transfusion in patients having cardiac surgery. Circulation 2007, 116:2544–2552.
Ferraris VA, Brown JR, Despotis GJ, Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion: 2011 Update tothe Society of Thoracic surgeons and the society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 2011, 91:944–982.
Karkouti K, Wijeysundera DN, Yau TM, McCluskey SA, Chan CT, Wong PY, Crowther MA, Hozhabri S, Beattie WS: Advance targeted transfusion in anemic cardiac surgical patients for kidney protection: an unblinded randomized pilot clinical trial. Anesthesiology 2012, 116:613–621.
Saba Riaz, Imran khan, Saira Gul: Effect of Preoperative Anemia on outcome after Cardiac Surgery, The Journal of Cardiovascular Diseases 2013, Vol.11 Issue 3.