Determining sex-specific preoperative haemoglobin levels associated with intraoperative red blood cell transfusion in cardiac surgery: a retrospective cohort study

Leonardo B Cavalli; Bronwyn L Pearse; Alison Craswell; Christopher M Anstey; Rishendran Naidoo; Ivan L Rapchuk; Joanne Perel; Kylie Hobson; Mingzhong Wang; Yoke-Lin Fung

doi:10.1016/j.bja.2023.06.062

Determining sex-specific preoperative haemoglobin levels associated with intraoperative red blood cell transfusion in cardiac surgery: a retrospective cohort study

Br J Anaesth. 2023 Oct;131(4):653-663. doi: 10.1016/j.bja.2023.06.062. Epub 2023 Aug 29.

Authors

Affiliations

¹ School of Health, University of the Sunshine Coast, Birtinya, QLD, Australia; School of Science, Technology and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, Australia; Sunshine Coast Health Institute, Birtinya, QLD, Australia. Electronic address: leonardo.cavalli@research.usc.edu.au.
² Blood Management, The Prince Charles Hospital, Brisbane, QLD, Australia.
³ School of Health, University of the Sunshine Coast, Birtinya, QLD, Australia; Sunshine Coast Health Institute, Birtinya, QLD, Australia.
⁴ School of Medicine, Sunshine Coast Campus, Griffith University, Birtinya, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
⁵ Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia.
⁶ Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Anaesthesia and Perfusion Department, The Prince Charles Hospital, Brisbane, QLD, Australia.
⁷ Pathology Queensland, Queensland Health, Brisbane, QLD, Australia.
⁸ School of Science, Technology and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, Australia.
⁹ School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia.

PMID: 37718096
DOI: 10.1016/j.bja.2023.06.062

Abstract

Background: Anaemic cardiac surgery patients are at greater risk of intraoperative red blood cell transfusion. This study questions the application of the World Health Organization population-based anaemia thresholds (haemoglobin <120 g L^-1 in non-pregnant females and <130 g L^-1 in males) as appropriate preoperative optimisation targets for cardiac surgery.

Methods: A retrospective cohort study was conducted on adults ≥18 yr old undergoing cardiopulmonary bypass surgery. Logistic regression was applied to define sex-specific preoperative haemoglobin concentrations with reduced probability of intraoperative red blood cell transfusion for cardiac surgery patients.

Results: Data on 4384 male and 1676 female patients were analysed. Binarily stratified multivariable logistic regression odds of receiving intraoperative red blood cell transfusion increased in cardiac surgery patients >45 yr old (odds ratio [OR] 1.84; 95% confidence interval [CI] 1.33-2.55), surgery urgency <30 days (OR 2.03; 95% CI 1.66-2.48), combined coronary artery bypass grafting and valve surgery, or other surgery types (OR 2.24; 95% CI 1.87-2.67), and female sex (OR 1.92; 95% CI 1.62-2.28). The odds decreased by 8.4% with each 1 g L^-1 increase in preoperative haemoglobin (OR 0.92; 95% CI 0.91-0.92). Logistic regression predicted females required a preoperative haemoglobin concentration of 133 g L^-1 and males 127 g L^-1 to have a 15% probability of intraoperative transfusion.

Conclusions: The World Health Organization female anaemia threshold of haemoglobin <120 g L^-1 disproportionately disadvantages female cardiac surgery patients. A preoperative haemoglobin concentration ≥130 g L^-1 in adult cardiac surgery patients would minimise their overall probability of intraoperative red blood cell transfusion to <15%.

Keywords: anaemia; cardiac surgery; haemoglobin; patient blood management; transfusion.

MeSH terms

Adult
Cardiac Surgical Procedures*
Coronary Artery Bypass
Erythrocyte Transfusion*
Female
Humans
Male
Probability
Retrospective Studies