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Cardiac surgery patients with anemia face higher risks

Sunday October 7, 2012
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Anemia has been confirmed as a risk factor for illness and even death following cardiac surgery, according to an Italian study.

Although preoperative anemia has been linked to adverse events in other types of surgery, this is the first study to tie preoperative anemia with postoperative complications, including death, for all types of heart surgery, the researchers said.

As reported in the October issue of the Annals of Thoracic surgery, researchers from Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato in Milan, Italy, compared recorded medical outcomes for 401 adult cardiac surgery patients with severe anemia (hematocrit less than 30%) with 401 matched non-severely anemic heart surgery patients admitted to IRCCS between 2000 and 2011.

They found that patients with severe anemia had nearly double the operative mortality rate of patients who did not have severe anemia, and were at increased risk for stroke, prolonged mechanical ventilation and longer stays in the ICU.

Further investigation found similar results in patients with moderate anemia.

“Unlike other recognized risk factors for cardiac surgery patients, such as advanced age and poor kidney function, anemia can be corrected with iron supplementation and medications that stimulate red blood cell production,” Marco Ranucci, MD, the study’s lead author, said in a news release.

“Unfortunately, to correct anemia we need two to three weeks before the operation, which may be too long for many patients to wait.”

Older adults are at risk for iron-deficiency anemia, which may result from blood loss, iron-poor diet or insufficient iron absorption from food. Preoperative anemia has not been considered a risk factor for survival following heart surgery, although anemia’s role previously had been investigated in outcomes for coronary artery bypass grafting surgery.

“Until it can be clearly demonstrated that correcting anemia improves outcomes, I think that working to correct and preserve the natural hemoglobin in a patient’s blood prior to surgery is a viable and safe option,” Ranucci said.

In an invited commentary, Jeremiah R. Brown, PhD, MS, an assistant professor at The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine in Hanover, N.H., wrote that the Ranucci paper presents a convincing case for adding severe anemia to cardiac surgery preoperative mortality models.

“Dr. Ranucci’s work demonstrates that cardiac surgeons need to know about the preoperative presence of severe anemia when estimating the operative mortality risk,” Brown wrote. “Doing so will provide patients with a more accurate estimate of operative risk than currently available in our risk models for informing surgeons and patients about the possible risks of surgery.”

Brown added that certain diagnostic procedures could be planned well ahead of elective surgeries, such as CABG surgery, to help identify anemia and provide time to treat it. “This extra time would allow surgeons to review the results and determine a strategic plan.”

The study abstract is available at http://bit.ly/Riro6l.


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