P066.Baseline Hemoglobin as a Predictor of Outcomes Following Total Aortic Arch Replacement
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Colorado Anschutz Medical Center
Aurora, CO
United States - Contact Me
I am a fourth year general surgery resident at the University of Colorado. I have a background in clinical reseach and hold a Masters in Clinical Research from the University of Michigan School of Public Health. I'm interested in clinical outcomes in aortic surgery and heart failure.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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 total arch replacement.
Methods: We performed a retrospective review of prospectively collected clinical data from all patients undergoing elective aortic arch reconstruction with a total arch replacement at a single tertiary care center from August 2009 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: One-hundred and forty patients met the inclusion criteria and underwent elective aortic arch reconstruction with total arch replacement. Ten (7.0%) underwent Ishimaru Zone 1 replacement, 29 (20.4%) underwent Zone 2 replacement, 2 (1.4%) underwent Zone 3 replacement, 3 (2.1%) underwent Zone 4 replacement, and 97 (68.3%) underwent frozen elephant trunk replacement. 92 patients (64.8%) were male, with a median age of 61.8 (IQR 51.9 – 70.0) years. Median BMI was 27.8 (IQR 24.3 – 31.5).
Preoperative baseline hemoglobin was 13.0 (±2.01) g/dL, platelets were 209 (±61.1) 109/L, and international normalized ratio was 1.16 (±0.247).
Postoperative outcomes are shown in Table 1.
On univariate analysis, age 65 or greater (OR 3.99, 95% CI [1.87–9.10], p = 0.001), coronary artery disease (OR 6.28, 95% CI [2.05–27.45], p = 0.012), and history of pulmonary disease (OR 2.48, 95% CI [1.07–6.30], p = 0.042) were associated with postoperative complications. No preoperative factors were statistically significant predictors of intraoperative transfusion.
On multivariate analysis, adjusting for preoperative platelet count, gender, diabetes, coronary artery disease, pulmonary disease, chronic kidney disease, and history of aortic surgery, only age 65 or greater (OR 3.44, 95% CI [1.32–9.69], p = 0.014) remained a statistically significant predictor of postoperative complications.
Conclusions: Our findings indicate that preoperative hemoglobin levels were not associated with intraoperative transfusion or postoperative complications, suggesting that optimizing intraoperative oxygen delivery may mitigate the risks associated with anemia. This contrasts with previously published data, potentially due to our institution's specific practices in oxygen delivery optimization.
Authors
Michael Kirsch (1), Adam Carroll (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
Methods: We performed a retrospective review of prospectively collected clinical data from all patients undergoing elective aortic arch reconstruction with a total arch replacement at a single tertiary care center from August 2009 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: One-hundred and forty patients met the inclusion criteria and underwent elective aortic arch reconstruction with total arch replacement. Ten (7.0%) underwent Ishimaru Zone 1 replacement, 29 (20.4%) underwent Zone 2 replacement, 2 (1.4%) underwent Zone 3 replacement, 3 (2.1%) underwent Zone 4 replacement, and 97 (68.3%) underwent frozen elephant trunk replacement. 92 patients (64.8%) were male, with a median age of 61.8 (IQR 51.9 – 70.0) years. Median BMI was 27.8 (IQR 24.3 – 31.5).
Preoperative baseline hemoglobin was 13.0 (±2.01) g/dL, platelets were 209 (±61.1) 109/L, and international normalized ratio was 1.16 (±0.247).
Postoperative outcomes are shown in Table 1.
On univariate analysis, age 65 or greater (OR 3.99, 95% CI [1.87–9.10], p = 0.001), coronary artery disease (OR 6.28, 95% CI [2.05–27.45], p = 0.012), and history of pulmonary disease (OR 2.48, 95% CI [1.07–6.30], p = 0.042) were associated with postoperative complications. No preoperative factors were statistically significant predictors of intraoperative transfusion.
On multivariate analysis, adjusting for preoperative platelet count, gender, diabetes, coronary artery disease, pulmonary disease, chronic kidney disease, and history of aortic surgery, only age 65 or greater (OR 3.44, 95% CI [1.32–9.69], p = 0.014) remained a statistically significant predictor of postoperative complications.
Conclusions: Our findings indicate that preoperative hemoglobin levels were not associated with intraoperative transfusion or postoperative complications, suggesting that optimizing intraoperative oxygen delivery may mitigate the risks associated with anemia. This contrasts with previously published data, potentially due to our institution's specific practices in oxygen delivery optimization.
Authors
Michael Kirsch (1), Adam Carroll (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions
(1) University of Colorado Anschutz, Denver, CO
Presentation Duration
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