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再次心脏手术中术前贫血的预后影响:单中心倾向匹配分析

Prognostic Implication of Preoperative Anemia in Redo Cardiac Surgery: A Single-Center Propensity-Matched Analysis.

作者信息

Rubino Antonino Salvatore, De Santo Luca Salvatore, Montella Antonio Pio, Golini Petrarcone Caterina, Palmieri Lucrezia, Galbiati Denise, Galdieri Nicola, De Feo Marisa

机构信息

Cardio-Thoraco-Vascular Department, Division of Cardiac Surgery, Papardo Hospital, 98158 Messina, Italy.

Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Via Leonardo Bianchi, 80131 Neaples, Italy.

出版信息

J Cardiovasc Dev Dis. 2023 Apr 6;10(4):160. doi: 10.3390/jcdd10040160.

Abstract

Preoperative anemia has been associated with increased morbidity and mortality after cardiac surgery, but little is known about its prognostic value in the setting of redo procedure. A retrospective, observational cohort study of prospectively collected data was undertaken on 409 consecutive patients referred for redo cardiac procedures between January 2011 and December 2020. The EuroSCORE II calculated an average mortality risk of 25.7 ± 15.4%. Selection bias was assessed with the propensity-adjustment method. The prevalence of preoperative anemia was 41%. In unmatched analysis, significant differences between the anemic and nonanemic groups emerged in the risk for postoperative stroke (0.6% vs. 4.4%, = 0.023), postoperative renal dysfunction (29.7% vs. 15.6%, = 0.001), a need for prolonged ventilation (18.1% vs. 7.2%, = 0.002), and high-dosage inotropes (53.1% vs. 32.9%, < 0.001) along with both length of ICU and hospital stay (8.2 ± 15.9 vs. 4.3 ± 5.4 days, = 0.003 and 18.8 ± 17.4 vs. 14.9 ± 11.1, = 0.012). After propensity matching (145 pairs), preoperative anemia was still significantly associated with postoperative renal dysfunction, stroke, and the need for high-dosage inotrope cardiac morbidity. Preoperative anemia is significantly associated with acute kidney injury, stroke, and the need for high-dosage inotropes in patients referred for redo procedures.

摘要

术前贫血与心脏手术后发病率和死亡率的增加有关,但对于其在再次手术中的预后价值知之甚少。我们对2011年1月至2020年12月期间连续409例接受再次心脏手术的患者进行了一项回顾性观察队列研究,这些数据是前瞻性收集的。欧洲心脏手术风险评估系统(EuroSCORE II)计算出平均死亡风险为25.7±15.4%。采用倾向调整法评估选择偏倚。术前贫血的患病率为41%。在未匹配分析中,贫血组和非贫血组在术后中风风险(0.6%对4.4%,P = 0.023)、术后肾功能不全(29.7%对15.6%,P = 0.001)、需要长时间通气(18.1%对7.2%,P = 0.002)、高剂量血管活性药物使用(53.1%对32.9%,P < 0.001)以及重症监护病房(ICU)住院时间和住院总时间方面(8.2±15.9天对4.3±5.4天,P = 0.003;18.8±17.4天对14.9±11.1天,P = 0.012)出现了显著差异。在倾向匹配(145对)后,术前贫血仍与术后肾功能不全、中风以及高剂量血管活性药物治疗的心脏发病率显著相关。对于接受再次手术的患者,术前贫血与急性肾损伤、中风以及高剂量血管活性药物的使用显著相关。

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