Effects of Preoperative Anemia On Advanced Healthcare Utilization Following Cardiac Surgery
•Preoperative anemia affects 20–50% of cardiac surgery patients and is exacerbated by inflammation and hemodilution associated with cardiopulmonary bypass [1].
•Preoperative anemia increases risks of organ dysfunction, kidney injury, infections, and higher transfusion rates [2].
•Identifying severity thresholds could improve perioperative risk stratification and guide optimization strategies in early detection and management of anemia.
Is preoperative anemia and its severityassociated with postoperative healthcare utilization (HCU) in patients undergoing cardiac surgery?
EXPOSURE
•Anemia 3 days prior to the procedure, defined by the last hemoglobin valuewithin this range
•Anemia severity (Figure 1), per WHO criteria [3]
- Mild anemia: <12 g/dL (women), <13 g/dL (men)
- Moderate/severe anemia: <11 g/dL
OUTCOMES
•Primary: Composite of unplanned ICU admission, hospital readmission within 30 days, non-home discharge, or in-hospital mortality
•Secondary:
- Postoperative hospital length of stay
- Acute kidney injury
- Perioperative neurocognitive impairment (composite of new onset delirium, mild cognitive impairment, or stroke) [4]
STATISTICAL ANALYSIS
•Multivariable logistic and negative binomial regression analysis adjusted for demographics, comorbidities and operative characteristics (Table 1)
Of 2,320 patients (44.4%) with preoperative anemia, 833 (35.9%) required advanced postoperative care following cardiac surgery
PRIMARY ANALYSIS
•Preoperative anemia was associated with higher odds of advanced HCU (ORadj 1.23, 95% CI 1.07–1.43, p=0.005),
•Moderate-to-severe anemia showed a significant increased risk (ORadj 1.40, 95% CI 1.14–1.70, p=0.001),
•Mild anemia showed a numerical increase (ORadj 1.16, 95% CI 0.99–1.37, p=0.068).
SECONDARY ANALYSIS
•Postoperative hospital stay: increased with anemia (IRR 1.09, 95% CI 1.06–1.13, p =<0.001) and showed a stepwise increase with greater anemia severity
•AKI: incidence increased progressively with anemia severity (ORadj 1.7, 95% CI 1.46–1.98, p=<0.001)
•Neurocognitive impairment: no significant association with anemia or anemia severity
Conclusion
•Preoperative anemia was associated with a higher likelihood of advanced postoperative healthcare utilization after cardiac surgery
•This association was severity-dependent, driven primarily by moderate–severe anemia
•Further evidence is needed to determine whether incorporating anemia severity into preoperative evaluation could help reduce complications and high-intensity resource use.
