Surgery Medical News about preoperative hemaglobin level;survival after coronary artery bypass grafting

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Preoperative hemoglobin level as a predictor of survival after coronary artery bypass grafting. A comparison with the matched general population
Circulation, 07/02/09

van Straten AHM et al. – A lower preoperative hemoglobin level is an independent predictor of late mortality in pts undergoing coronary artery bypass grafting (CABG); anemia is a risk factor for early and late mortality. Compared with the general population, anemic pts had worse survival than expected; nonanemic pts had better survival than expected.

Methods

Study of how the preoperative hemoglobin level affects pt survival after CABG
Comparison of late mortality for CABG pts vs general population
Determination of early and late mortality of all consecutive pts undergoing isolated CABG January 1998-December 2007
Classification into 4 groups stratified by preoperative hemoglobin level
Cutoff point for anemia: 13 g/dL men; 12 g/dL women
Expected survival of matched general Dutch population cohort from Dutch Central Bureau for Statistics database
Exclusion of 122 pts lost to follow-up and 481 with missing preoperative hemoglobin levels

Results

Complete data for 10,025 pts
On multivariate logistic regression analyses, anemia was independent risk factor for higher early mortality
On Cox regression analyses, low hemoglobin level, both as a continuous variable and as a dichotomous variable (anemia), was a predictor of higher late mortality
Compared with expected survival, pts with lowest preoperative hemoglobin levels had a worse outcome; pts with highest hemoglobin levels had better outcome

Exclusive Author Commentary
MA Soliman Hamad, 07/03/09

Dear colleagues, This paper highlights the predictive value of preoperative anemia on early and late mortality after CABG. The thorough diagnosis and management of anemia is of outmost importance in improving the outcome of CABG. To our knowledge, this is one of the few papers, perhaps the only paper, in the literature comparing survival of CABG patients with the survival of matched cohorts of the general population. These cohorts are matched for age, sex with the patient groups. Preoperative patient information should also include comparison between their prognosis and the survival of their neighbors, colleagues or friends of the same age and sex and who are apparently healthy subjects. On behalf of the authors MA Soliman Hamad

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