Does Preoperative Hemoglobin Independently Predict Short-Term Outcomes After Coronary Artery Bypass Graft Surgery?

Melanie L Bell, Gary K. Grunwald, Janet H. Baltz, Gerald O. McDonald, Missy R. Bell, Frederick L. Grover, A. Laurie W Shroyer

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: The role of preoperative hemoglobin in predicting short-term coronary artery bypass graft (CABG) surgery outcomes has not been well established. This study investigated the association between preoperative hemoglobin level with 30-day operative mortality and perioperative complications. Methods: For the period from 1997 to 2005, the Department of Veterans Affairs Continuous Improvement in Cardiac Surgery Program database was used to extract 36,658 CABG-only deidentified records for patients undergoing cardiopulmonary bypass. Univariate and multivariate statistical models were used to predict both mortality and morbidity outcomes for varying levels of hemoglobin. Results: Unadjusted odds of 30-day operative mortality for patients with preoperative hemoglobin level less than 10 g/dL were 2.37 times higher than for patients with hemoglobin levels of 10 g/dL or greater (95% confidence interval: 1.84 to 3.05; p < 0.0001). Multivariable effect upon 30-day operative mortality decreased considerably (odds ratio = 1.29, 95% confidence interval: 0.99 to 1.68; p = 0.064). Conclusions: As several risk factors may occur concurrently with low hemoglobin, preoperative hemoglobin level less than 10 g/dL was not a strong independent predictor of 30-day operative mortality or perioperative morbidity in multivariate models for on-pump CABG-only patients. Hemoglobin and serum creatinine were correlated, with creatinine exhibiting the stronger association with mortality. These findings suggest that moderate or severe anemia may be intertwined with other risk factors, such as serum creatinine or congestive heart failure. For a CABG patient subgroup presenting with a complex clinical preoperative profile, therefore, risk-model approaches may be inherently limited in separately identifying the predictors of anemic patients' outcomes.

Original languageEnglish (US)
Pages (from-to)1415-1423
Number of pages9
JournalAnnals of Thoracic Surgery
Volume86
Issue number5
DOIs
StatePublished - Nov 2008
Externally publishedYes

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Coronary Artery Bypass
Hemoglobins
Transplants
Mortality
Creatinine
Confidence Intervals
Morbidity
Statistical Models
Veterans
Serum
Cardiopulmonary Bypass
Thoracic Surgery
Anemia
Heart Failure
Odds Ratio
Databases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Does Preoperative Hemoglobin Independently Predict Short-Term Outcomes After Coronary Artery Bypass Graft Surgery? / Bell, Melanie L; Grunwald, Gary K.; Baltz, Janet H.; McDonald, Gerald O.; Bell, Missy R.; Grover, Frederick L.; Shroyer, A. Laurie W.

In: Annals of Thoracic Surgery, Vol. 86, No. 5, 11.2008, p. 1415-1423.

Research output: Contribution to journalArticle

Bell, Melanie L ; Grunwald, Gary K. ; Baltz, Janet H. ; McDonald, Gerald O. ; Bell, Missy R. ; Grover, Frederick L. ; Shroyer, A. Laurie W. / Does Preoperative Hemoglobin Independently Predict Short-Term Outcomes After Coronary Artery Bypass Graft Surgery?. In: Annals of Thoracic Surgery. 2008 ; Vol. 86, No. 5. pp. 1415-1423.
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abstract = "Background: The role of preoperative hemoglobin in predicting short-term coronary artery bypass graft (CABG) surgery outcomes has not been well established. This study investigated the association between preoperative hemoglobin level with 30-day operative mortality and perioperative complications. Methods: For the period from 1997 to 2005, the Department of Veterans Affairs Continuous Improvement in Cardiac Surgery Program database was used to extract 36,658 CABG-only deidentified records for patients undergoing cardiopulmonary bypass. Univariate and multivariate statistical models were used to predict both mortality and morbidity outcomes for varying levels of hemoglobin. Results: Unadjusted odds of 30-day operative mortality for patients with preoperative hemoglobin level less than 10 g/dL were 2.37 times higher than for patients with hemoglobin levels of 10 g/dL or greater (95{\%} confidence interval: 1.84 to 3.05; p < 0.0001). Multivariable effect upon 30-day operative mortality decreased considerably (odds ratio = 1.29, 95{\%} confidence interval: 0.99 to 1.68; p = 0.064). Conclusions: As several risk factors may occur concurrently with low hemoglobin, preoperative hemoglobin level less than 10 g/dL was not a strong independent predictor of 30-day operative mortality or perioperative morbidity in multivariate models for on-pump CABG-only patients. Hemoglobin and serum creatinine were correlated, with creatinine exhibiting the stronger association with mortality. These findings suggest that moderate or severe anemia may be intertwined with other risk factors, such as serum creatinine or congestive heart failure. For a CABG patient subgroup presenting with a complex clinical preoperative profile, therefore, risk-model approaches may be inherently limited in separately identifying the predictors of anemic patients' outcomes.",
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AB - Background: The role of preoperative hemoglobin in predicting short-term coronary artery bypass graft (CABG) surgery outcomes has not been well established. This study investigated the association between preoperative hemoglobin level with 30-day operative mortality and perioperative complications. Methods: For the period from 1997 to 2005, the Department of Veterans Affairs Continuous Improvement in Cardiac Surgery Program database was used to extract 36,658 CABG-only deidentified records for patients undergoing cardiopulmonary bypass. Univariate and multivariate statistical models were used to predict both mortality and morbidity outcomes for varying levels of hemoglobin. Results: Unadjusted odds of 30-day operative mortality for patients with preoperative hemoglobin level less than 10 g/dL were 2.37 times higher than for patients with hemoglobin levels of 10 g/dL or greater (95% confidence interval: 1.84 to 3.05; p < 0.0001). Multivariable effect upon 30-day operative mortality decreased considerably (odds ratio = 1.29, 95% confidence interval: 0.99 to 1.68; p = 0.064). Conclusions: As several risk factors may occur concurrently with low hemoglobin, preoperative hemoglobin level less than 10 g/dL was not a strong independent predictor of 30-day operative mortality or perioperative morbidity in multivariate models for on-pump CABG-only patients. Hemoglobin and serum creatinine were correlated, with creatinine exhibiting the stronger association with mortality. These findings suggest that moderate or severe anemia may be intertwined with other risk factors, such as serum creatinine or congestive heart failure. For a CABG patient subgroup presenting with a complex clinical preoperative profile, therefore, risk-model approaches may be inherently limited in separately identifying the predictors of anemic patients' outcomes.

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