Department of Surgery, University of Louisville, Louisville, Kentucky.
Ann Thorac Surg. 2013 Nov;96(5):1628-34; discussion 1634. doi: 10.1016/j.athoracsur.2013.06.030. Epub 2013 Sep 20.
Small series have identified a relationship between preoperative hematocrit (HCT) and outcomes in coronary artery bypass graft (CABG) surgery. The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) began collecting preoperative HCT data in 2008. In this study, analyses were performed to determine the impact of preoperative HCT on perioperative morbidity and mortality among patients undergoing isolated CABG.
Data were collected on 182,599 patients who underwent primary isolated on-pump CABG between 2008 and 2009 and were included in the STS ACSD. Data were included only from centers that performed more than 100 on-pump cases per year during the period of study. Dialysis patients as well as those with previous cardiovascular operations or missing data for HCT were excluded. We then performed multivariable analysis using the 2008 STS CABG risk model as a guide, including HCT as a predictor. Logistic regression was performed for operative mortality and other adverse outcomes.
Overall operative mortality was 1.6% (3,005 of 182,599). Compared with patients with anemia (HCT <33%), patients with HCT of at least 42% had lower mortality (1.1% versus 3.4%; p < 0.0001) and lower rates of renal failure (2.0% versus 7.8%; p < 0.0001), stroke (0.9% versus 1.8%; p < 0.0001), prolonged ventilation (8.4% versus 17.5%; p < 0.0001), and deep sternal wound infection (0.3% versus 0.6%; p < 0.0001). In adjusted analyses, each 5-point decrease in preoperative HCT was associated with an 8% higher odds of death (odds ratio, 1.08; p = 0.0003), a 22% increase in the odds of postoperative renal failure (odds ratio, 1.22; p < 0.0001), and a 10% increase in the risk of deep sternal wound infection (odds ratio, 1.10; p < 0.01). Similar results were observed among patients (n = 74,292) undergoing elective CABG. The percentage of patients receiving perioperative blood transfusion decreased from 88.5% in the anemic group (HCT <33%) to 32.5% in patients with HCT of at least 42% (p < 0.0001).
Preoperative HCT is a powerful independent predictor of perioperative mortality as well as renal failure and deep sternal wound infection in patients undergoing isolated primary CABG operations. These findings should prompt investigation of strategies to increase preoperative HCT.
小样本研究已经确定了术前血细胞比容（HCT）与冠状动脉旁路移植术（CABG）手术结果之间的关系。胸外科医师学会（STS）成人心脏手术数据库（ACSD）于 2008 年开始收集术前 HCT 数据。在这项研究中，进行了分析以确定术前 HCT 对接受单纯 CABG 患者围手术期发病率和死亡率的影响。
收集了 2008 年至 2009 年期间接受原发性单纯体外循环 CABG 的 182599 例患者的数据，并纳入 STS ACSD。仅纳入在研究期间每年进行超过 100 例体外循环手术的中心的数据。排除透析患者以及既往心血管手术或 HCT 数据缺失的患者。然后，我们使用 2008 年 STS CABG 风险模型作为指导进行多变量分析，包括 HCT 作为预测因子。对手术死亡率和其他不良结果进行 logistic 回归分析。
总体手术死亡率为 1.6%（3005/182599）。与贫血患者（HCT<33%）相比，HCT 至少为 42%的患者死亡率较低（1.1%对 3.4%；p<0.0001），肾衰竭发生率较低（2.0%对 7.8%；p<0.0001），中风发生率较低（0.9%对 1.8%；p<0.0001），通气时间延长（8.4%对 17.5%；p<0.0001），深部胸骨伤口感染率较低（0.3%对 0.6%；p<0.0001）。在调整分析中，术前 HCT 每降低 5 个点，死亡的几率就会增加 8%（优势比，1.08；p=0.0003），术后肾衰竭的几率增加 22%（优势比，1.22；p<0.0001），深部胸骨伤口感染的风险增加 10%（优势比，1.10；p<0.01）。在接受择期 CABG 的患者（n=74292）中观察到了类似的结果。接受围手术期输血的患者比例从贫血组（HCT<33%）的 88.5%降至 HCT 至少为 42%的患者的 32.5%（p<0.0001）。
术前 HCT 是接受单纯原发性 CABG 手术患者围手术期死亡率以及肾衰竭和深部胸骨伤口感染的强有力独立预测因子。这些发现应促使人们探索增加术前 HCT 的策略。
