This research was funded by Sanquin Blood Supply, the Netherlands.
Tolerance of intraoperative hemoglobin decrease during cardiac surgery
Article first published online: 14 APR 2014
© 2014 AABB
Special Issue: The evolving paradigm of patient blood management
Volume 54, Issue 10pt2, pages 2696–2704, October 2014
How to Cite
Hogervorst, E., Rosseel, P., van der Bom, J., Bentala, M., Brand, A., van der Meer, N. and van de Watering, L. (2014), Tolerance of intraoperative hemoglobin decrease during cardiac surgery. Transfusion, 54: 2696–2704. doi: 10.1111/trf.12654
- Issue published online: 10 OCT 2014
- Article first published online: 14 APR 2014
- Manuscript Revised: 18 FEB 2014
- Manuscript Accepted: 18 FEB 2014
- Manuscript Received: 18 DEC 2013
- Sanquin Blood Supply, the Netherlands
It has been suggested that a decrease of at least 50% from the preoperative hemoglobin (Hb) level during cardiac surgery is associated with adverse outcomes even if the absolute Hb level remains above the commonly used transfusion threshold of 7.0 g/dL. In this study the relation between intraoperative Hb decline of at least 50% and a composite endpoint was analyzed.
Study Design and Methods
This single-center study comprised 11,508 patients who underwent cardiac surgery and had normal preoperative Hb levels (12.0-16.0 g/dL in women, 13.0-18.0 g/dL in men) between January 2001 and December 2011. Logistic regression modeling was used. The composite endpoint comprised in-hospital mortality, stroke, myocardial infarction, and renal failure.
Patients whose Hb did not decrease at least 50% and remained above 7 g/dL were used as reference (n = 9672). A total of 363 (3.2%) patients had an intraoperative Hb of less than 7 g/dL during surgery but a Hb decrease of less than 50%; 876 patients (7.4%) showed both a nadir Hb less than 7 g/dL and a Hb decrease of at least 50%, while 597 (5.2%) had a Hb decrease of at least 50% and a nadir Hb of at least 7 g/dL. In this last group the incidence of the composite endpoint was higher than in patients in the reference group (adjusted odds ratio, 1.27; 95% confidence interval, 1.14-1.41).
Our findings show that a decrease of at least 50% from baseline Hb during cardiac surgery is associated with adverse outcomes, even if the absolute Hb level remains higher than the commonly used transfusion threshold of 7.0 g/dL.