Dr Siaw Wee Teo, Dr Joanna R Kent1,2, Prof Julian A Smith3,4, A/Prof Kevan R Polkinghorne1,2, Prof Peter G Kerr1,2
1Department of Nephrology, Monash Health, Clayton, Australia, 2School of Clinical Sciences, Monash University, Clayton, Australia, 3Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia, 4Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, Australia
Biography:
Siaw Wee is a nephrology advanced trainee in her second year who has interests in perioperative medicine.
Aim:
To assess the prevalence of anaemia before, and outcomes following, cardiac surgery requiring cardiopulmonary bypass (CPB) in patients with chronic kidney disease (CKD) Stages 3-5.
Background:
Preoperative anaemia is associated with increased mortality and postoperative complications. International guidelines recommend optimising haemoglobin (Hb) preoperatively, but there is a paucity of data examining preoperative Hb targets in patients with CKD, including those requiring dialysis.
Methods:
A retrospective cohort analysis was conducted on 515 patients with eGFR <60 mL/min/1.73m² or on dialysis who underwent surgery requiring CPB between 1/1/2013-31/12/2023, utilising the ANZSCTS Cardiac Surgery Database. Anaemia was defined as a Hb <130g/L in men and <120g/L in women. Outcomes included 30-day mortality, morbidity (MI, heart failure, cerebrovascular events or infections) and length of hospital stay (LOS).
Results:
The mean preoperative Hb for males and females was 123±2.10g/L and 115±1.49g/L, respectively; 61.75% of the cohort had anaemia. Each 10g/L increase in preoperative Hb was associated with reduced 30-day mortality (OR 0.73, 95% CI 0.60–0.89, p=0.002) and LOS of 0.90 days (95%CI 0.27-1.53 days, p=0.005 ). Compared to patients with a preoperative Hb>140g/L, those with Hb<100g/L had 6-16 times greater mortality (Hb 81-100g/L, OR 6.53, p=0.026; Hb80g/L, OR 16.7, p=0.009) while patients with Hb 100-140g/L did not have increased mortality. Each 10g/L increase in Hb was associated with a reduced risk of cardiovascular (OR 0.81, 95% CI 0.68-0.97, p=0.023), but not cerebrovascular, events or postoperative infections.
Conclusions:
In patients with CKD 3-5 or on dialysis, a preoperative Hb>100g/L was associated with better outcomes following cardiac surgery requiring CPB. Optimising preoperative Hb may be a modifiable risk factor in this high-risk group.
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