Determining sex-specific preoperative haemoglobin levels associated with intraoperative red blood cell transfusion in cardiac surgery: a retrospective cohort study.
| Autor: | Cavalli LB; School of Health, University of the Sunshine Coast, Birtinya, QLD, Australia; School of Science, Technology and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, Australia; Sunshine Coast Health Institute, Birtinya, QLD, Australia. Electronic address: leonardo.cavalli@research.usc.edu.au., Pearse BL; Blood Management, The Prince Charles Hospital, Brisbane, QLD, Australia., Craswell A; School of Health, University of the Sunshine Coast, Birtinya, QLD, Australia; Sunshine Coast Health Institute, Birtinya, QLD, Australia., Anstey CM; School of Medicine, Sunshine Coast Campus, Griffith University, Birtinya, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia., Naidoo R; Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia., Rapchuk IL; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Anaesthesia and Perfusion Department, The Prince Charles Hospital, Brisbane, QLD, Australia., Perel J; Pathology Queensland, Queensland Health, Brisbane, QLD, Australia., Hobson K; Blood Management, The Prince Charles Hospital, Brisbane, QLD, Australia., Wang M; School of Science, Technology and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, Australia., Fung YL; School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia. |
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| Jazyk: | angličtina |
| Zdroj: | British journal of anaesthesia [Br J Anaesth] 2023 Oct; Vol. 131 (4), pp. 653-663. Date of Electronic Publication: 2023 Aug 29. |
| DOI: | 10.1016/j.bja.2023.06.062 |
| Abstrakt: | Background: Anaemic cardiac surgery patients are at greater risk of intraoperative red blood cell transfusion. This study questions the application of the World Health Organization population-based anaemia thresholds (haemoglobin <120 g L -1 in non-pregnant females and <130 g L -1 in males) as appropriate preoperative optimisation targets for cardiac surgery. Methods: A retrospective cohort study was conducted on adults ≥18 yr old undergoing cardiopulmonary bypass surgery. Logistic regression was applied to define sex-specific preoperative haemoglobin concentrations with reduced probability of intraoperative red blood cell transfusion for cardiac surgery patients. Results: Data on 4384 male and 1676 female patients were analysed. Binarily stratified multivariable logistic regression odds of receiving intraoperative red blood cell transfusion increased in cardiac surgery patients >45 yr old (odds ratio [OR] 1.84; 95% confidence interval [CI] 1.33-2.55), surgery urgency <30 days (OR 2.03; 95% CI 1.66-2.48), combined coronary artery bypass grafting and valve surgery, or other surgery types (OR 2.24; 95% CI 1.87-2.67), and female sex (OR 1.92; 95% CI 1.62-2.28). The odds decreased by 8.4% with each 1 g L -1 increase in preoperative haemoglobin (OR 0.92; 95% CI 0.91-0.92). Logistic regression predicted females required a preoperative haemoglobin concentration of 133 g L -1 and males 127 g L -1 to have a 15% probability of intraoperative transfusion. Conclusions: The World Health Organization female anaemia threshold of haemoglobin <120 g L -1 disproportionately disadvantages female cardiac surgery patients. A preoperative haemoglobin concentration ≥130 g L -1 in adult cardiac surgery patients would minimise their overall probability of intraoperative red blood cell transfusion to <15%. (Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.) |
| Databáze: | MEDLINE |
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