Baseline Hemoglobin as a Predictor of Outcomes Following Hemiarch Aortic Reconstruction
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0065
Submission Type:
Abstract Submission
Authors:
Michael Kirsch (1), Adam Carroll (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions:
(1) University of Colorado Anschutz, Denver, CO
Submitting Author:
Michael Kirsch
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University of Colorado Anschutz
University of Colorado Anschutz
Co-Author(s):
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
*Muhammad Aftab
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University of Colorado Anschutz
University of Colorado Anschutz
*T. Brett Reece
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University of Colorado Anschutz
University of Colorado Anschutz
Presenting Author:
Michael Kirsch
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Abstract:
Objective: Previous studies have shown that patients with preoperative anemia undergoing cardiac surgery more commonly experience postoperative complications. We sought to determine the association of preoperative hemoglobin level with postoperative outcomes following elective aortic arch reconstruction with hemiarch replacement.
Methods: We performed a retrospective review of prospectively collected clinical data from all patients undergoing elective aortic arch reconstruction with a hemiarch replacement at a single tertiary care center from February 2010 to October 2023. Data were retrieved from the electronic medical record. Postoperative complications were defined as either the presence of Society of Thoracic Surgeons ICU morbidity or postoperative death during their index hospitalization.
Results: Four-hundred and twenty-seven patients met the inclusion criteria. Three-hundred and twenty-seven (76.6%) were male and the median age was 62.1 (IQR 50.5 – 69.6) years. Median body mass index was 27.5 (IQR 24.4 – 31.9) and 50 (11.7%) patients had a history of diabetes. Thirty-nine (9.1%) patients had a history of previous aortic surgery.
Preoperative baseline hemoglobin was 13.7 (±1.84) g/dL, platelets were 221 (±64.0) 109/L, and international normalized ratio was 1.11 (±0.202).
Postoperative outcomes are shown in Table 1.
On univariate analysis, age 65 or greater (OR 1.94, 95% CI [1.31–2.88], p = 0.001), history of diabetes (OR 2.31, 95% CI [1.26–4.39], p = 0.008), history of coronary artery disease (OR 2.06, 95% CI [1.26–3.43], p = 0.004), and a history of chronic kidney disease (OR 2.10, 95% CI [1.03–4.50], p = 0.046) were independent predictors of postoperative complications. Baseline hemoglobin (OR 0.75, 95% CI [0.66–0.85], p < 0.001), baseline platelets (OR 1.00, 95% CI [0.99–1.00], p = 0.021), age 65 or greater (OR 3.73, 95% CI [2.34–6.10], p < 0.001), diabetes (OR 2.64, 95% CI [1.26–6.21], p = 0.016), history of stroke (OR 4.58, 95% CI [1.30–29.00], p = 0.043), and a history of aortic surgery (OR 2.71, 95% CI [1.18–7.32], p = 0.029) were independent predictors of intraoperative blood product transfusion.
On multivariate analysis adjusting for baseline hemoglobin, history of renal disease, diabetes, pulmonary disease, and coronary artery disease, only age 65 or greater (OR 1.55, 95% CI [1.01–2.36], p = 0.043) remained a significant predictor of complications. Preoperative baseline hemoglobin was not a statistically significant predictor of complications (p = 0.117). On multivariate analysis, adjusting for diabetes, coronary artery disease, and stroke, only baseline hemoglobin (OR 0.80, 95% CI [0.70–0.92], p = 0.002), baseline platelets (OR 1.00, 95% CI [0.99–1.00], p = 0.041), age 65 or greater (OR 3.27, 95% CI [1.96–5.60], p < 0.001), and history of aortic surgery (OR 2.68, 95% CI [1.12–7.48], p = 0.039) were significant predictors of intraoperative transfusion.
Conclusions: Preoperative hemoglobin is not associated with postoperative complications, but is associated with intraoperative blood transfusion. This suggests that our institutional practice of optimizing intraoperative delivery of oxygen may mitigate the risks associated with anemia.
Methods: We performed a retrospective review of prospectively collected clinical data from all patients undergoing elective aortic arch reconstruction with a hemiarch replacement at a single tertiary care center from February 2010 to October 2023. Data were retrieved from the electronic medical record. Postoperative complications were defined as either the presence of Society of Thoracic Surgeons ICU morbidity or postoperative death during their index hospitalization.
Results: Four-hundred and twenty-seven patients met the inclusion criteria. Three-hundred and twenty-seven (76.6%) were male and the median age was 62.1 (IQR 50.5 – 69.6) years. Median body mass index was 27.5 (IQR 24.4 – 31.9) and 50 (11.7%) patients had a history of diabetes. Thirty-nine (9.1%) patients had a history of previous aortic surgery.
Preoperative baseline hemoglobin was 13.7 (±1.84) g/dL, platelets were 221 (±64.0) 109/L, and international normalized ratio was 1.11 (±0.202).
Postoperative outcomes are shown in Table 1.
On univariate analysis, age 65 or greater (OR 1.94, 95% CI [1.31–2.88], p = 0.001), history of diabetes (OR 2.31, 95% CI [1.26–4.39], p = 0.008), history of coronary artery disease (OR 2.06, 95% CI [1.26–3.43], p = 0.004), and a history of chronic kidney disease (OR 2.10, 95% CI [1.03–4.50], p = 0.046) were independent predictors of postoperative complications. Baseline hemoglobin (OR 0.75, 95% CI [0.66–0.85], p < 0.001), baseline platelets (OR 1.00, 95% CI [0.99–1.00], p = 0.021), age 65 or greater (OR 3.73, 95% CI [2.34–6.10], p < 0.001), diabetes (OR 2.64, 95% CI [1.26–6.21], p = 0.016), history of stroke (OR 4.58, 95% CI [1.30–29.00], p = 0.043), and a history of aortic surgery (OR 2.71, 95% CI [1.18–7.32], p = 0.029) were independent predictors of intraoperative blood product transfusion.
On multivariate analysis adjusting for baseline hemoglobin, history of renal disease, diabetes, pulmonary disease, and coronary artery disease, only age 65 or greater (OR 1.55, 95% CI [1.01–2.36], p = 0.043) remained a significant predictor of complications. Preoperative baseline hemoglobin was not a statistically significant predictor of complications (p = 0.117). On multivariate analysis, adjusting for diabetes, coronary artery disease, and stroke, only baseline hemoglobin (OR 0.80, 95% CI [0.70–0.92], p = 0.002), baseline platelets (OR 1.00, 95% CI [0.99–1.00], p = 0.041), age 65 or greater (OR 3.27, 95% CI [1.96–5.60], p < 0.001), and history of aortic surgery (OR 2.68, 95% CI [1.12–7.48], p = 0.039) were significant predictors of intraoperative transfusion.
Conclusions: Preoperative hemoglobin is not associated with postoperative complications, but is associated with intraoperative blood transfusion. This suggests that our institutional practice of optimizing intraoperative delivery of oxygen may mitigate the risks associated with anemia.
Aortic Symposium:
Ascending Aorta
Image or Table
