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Pre- and postoperative anemia, acute kidney injury, and mortality after coronary artery bypass grafting surgery: a retrospective observational study.

Publication ,  Journal Article
Oprea, AD; Del Rio, JM; Cooter, M; Green, CL; Karhausen, JA; Nailer, P; Guinn, NR; Podgoreanu, MV; Stafford-Smith, M; Schroder, JN; Fontes, ML ...
Published in: Can J Anaesth
January 2018

BACKGROUND: Preoperative and postoperative anemia have been identified individually as potential risk factors for postoperative complications after coronary artery bypass grafting (CABG) surgery. Their interrelationship with acute kidney injury (AKI) and long-term mortality, however, has not been clearly defined and was the purpose of this study. METHODS: We retrospectively evaluated 6,130 adult patients undergoing CABG surgery performed at a single large academic medical center. Preoperative and postoperative hemoglobin concentrations were used as continuous predictors of postoperative AKI and mortality. Additionally, sex-specific preoperative (< 13 g·dL-1 in men and < 12 g·dL-1 in women) and postoperative anemia (the median of the lowest in-hospital values) were used as categorical predictors. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines, when serum creatinine rose ≥ 50% during the period between day of surgery and postoperative day ten, or when a 0.3 mg·dL-1 (26.5 μmol·L-1) increase was detected in a rolling 48-hr window from the day of surgery to the tenth postoperative day. The association of preoperative and postoperative hemoglobin levels and anemia patterns with postoperative AKI and mortality were assessed via univariable and multivariable Cox proportional hazard analyses with time-varying effects for postoperative serum hemoglobin concentrations. RESULTS: The median preoperative and median minimum postoperative serum hemoglobin concentrations were 13.1 g·dL-1 and 8.8 g·dL-1, respectively. The incidence of AKI was 58%. Overall, 1,880 (30.7%) patients died an average of 6.8 yr after surgery. After adjusting for differences in baseline and clinical characteristics, on any given day, patients with preoperative anemia (multivariable hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.13 to 1.33; P < 0.001) and those with a combination of preoperative and postoperative anemia (multivariable HR, 1.24; 95% CI, 1.09 to 1.40; P < 0.0008) were at an elevated risk for developing postoperative AKI and mortality (preoperative anemia: multivariable HR, 1.29; 95% CI, 1.15 to 1.44; P < 0.001; preoperative and postoperative anemia: multivariable HR, 1.50; 95% CI, 1.25 to 1.79; P < 0.001). CONCLUSIONS: Our findings suggest that preoperative anemia alone and preoperative anemia combined with postoperative anemia are associated with AKI and mortality after CABG surgery.

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Published In

Can J Anaesth

DOI

EISSN

1496-8975

Publication Date

January 2018

Volume

65

Issue

1

Start / End Page

46 / 59

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Proportional Hazards Models
  • Preoperative Period
  • Postoperative Period
  • Postoperative Complications
  • Middle Aged
  • Male
  • Incidence
  • Humans
 

Citation

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Oprea, A. D., Del Rio, J. M., Cooter, M., Green, C. L., Karhausen, J. A., Nailer, P., … Kertai, M. D. (2018). Pre- and postoperative anemia, acute kidney injury, and mortality after coronary artery bypass grafting surgery: a retrospective observational study. Can J Anaesth, 65(1), 46–59. https://doi.org/10.1007/s12630-017-0991-0
Oprea, Adriana D., J Mauricio Del Rio, Mary Cooter, Cynthia L. Green, Jörn A. Karhausen, Patrick Nailer, Nicole R. Guinn, et al. “Pre- and postoperative anemia, acute kidney injury, and mortality after coronary artery bypass grafting surgery: a retrospective observational study.Can J Anaesth 65, no. 1 (January 2018): 46–59. https://doi.org/10.1007/s12630-017-0991-0.
Oprea AD, Del Rio JM, Cooter M, Green CL, Karhausen JA, Nailer P, et al. Pre- and postoperative anemia, acute kidney injury, and mortality after coronary artery bypass grafting surgery: a retrospective observational study. Can J Anaesth. 2018 Jan;65(1):46–59.
Oprea, Adriana D., et al. “Pre- and postoperative anemia, acute kidney injury, and mortality after coronary artery bypass grafting surgery: a retrospective observational study.Can J Anaesth, vol. 65, no. 1, Jan. 2018, pp. 46–59. Pubmed, doi:10.1007/s12630-017-0991-0.
Oprea AD, Del Rio JM, Cooter M, Green CL, Karhausen JA, Nailer P, Guinn NR, Podgoreanu MV, Stafford-Smith M, Schroder JN, Fontes ML, Kertai MD. Pre- and postoperative anemia, acute kidney injury, and mortality after coronary artery bypass grafting surgery: a retrospective observational study. Can J Anaesth. 2018 Jan;65(1):46–59.
Journal cover image

Published In

Can J Anaesth

DOI

EISSN

1496-8975

Publication Date

January 2018

Volume

65

Issue

1

Start / End Page

46 / 59

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Proportional Hazards Models
  • Preoperative Period
  • Postoperative Period
  • Postoperative Complications
  • Middle Aged
  • Male
  • Incidence
  • Humans