Predictors of postoperative hematocrit and association of hematocrit with adverse outcomes for coronary artery bypass graft surgery patients with cardiopulmonary bypass

Edward L. Hannan, Zaza Samadashvili, Stephen J. Lahey, Alfred T. Culliford, Robert Higgins, Desmond Jordan, Jeffrey P. Gold, Craig R. Smith, Andrew Wechsler

Research output: Contribution to journalArticle

Abstract

Objective: To determine predictors of low intensive care unit (ICU) admission hematocrit, and to determine if low hematocrit is associated with postoperative outcomes for coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass. Methods: We performed a retrospective study of 8417 patients who underwent CABG surgery on cardiopulmonary bypass in New York in 2007. Patients with very low ICU admission hematocrit (≤21.9%) and low ICU admission hematocrit (22.0% to 25.9%) were identified. Significant independent predictors of low and very low ICU admission hematocrit, and the independent impact of each of these states on adverse outcomes were identified. Results: A total of 1.1% had very low hematocrit and 8.3% had low hematocrit. Significant independent predictors for either low or very low hematocrit included older age, females, lower body surface area, lower ventricular function, Hispanic ethnicity, non-Caucasian race, high creatinine, previous cardiac surgery, absence of left main disease, and emergency transfer to the operating room following catheterization or percutaneous coronary intervention. Patients with hematocrit 21.9% had significantly higher risk-adjusted rates of postoperative bleeding (adjusted OR = 4.37, 95% CI [1.97, 9.68, respiratory failure (adjusted OR = 2.85, 95% CI [1.45, 5.63]), and one or more complications than patients with normal hematocrit. Patients with hematocrit between 22.0% and 25.9% also had higher complication rates. Conclusion: It is important for cardiovascular surgical teams to be aware of risk factors that predispose patients to unacceptable hematocrit values, to monitor values closely, and to treat accordingly in the operating room when low values occur.

Original languageEnglish (US)
Pages (from-to)638-646
Number of pages9
JournalJournal of Cardiac Surgery
Volume25
Issue number6
DOIs
StatePublished - Nov 2010
Externally publishedYes

Fingerprint

Cardiopulmonary Bypass
Hematocrit
Coronary Artery Bypass
Transplants
Intensive Care Units
Operating Rooms
Ventricular Function
Body Surface Area
Percutaneous Coronary Intervention
Hispanic Americans
Catheterization
Respiratory Insufficiency
Thoracic Surgery
Creatinine
Emergencies
Retrospective Studies
Hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Predictors of postoperative hematocrit and association of hematocrit with adverse outcomes for coronary artery bypass graft surgery patients with cardiopulmonary bypass. / Hannan, Edward L.; Samadashvili, Zaza; Lahey, Stephen J.; Culliford, Alfred T.; Higgins, Robert; Jordan, Desmond; Gold, Jeffrey P.; Smith, Craig R.; Wechsler, Andrew.

In: Journal of Cardiac Surgery, Vol. 25, No. 6, 11.2010, p. 638-646.

Research output: Contribution to journalArticle

Hannan, Edward L. ; Samadashvili, Zaza ; Lahey, Stephen J. ; Culliford, Alfred T. ; Higgins, Robert ; Jordan, Desmond ; Gold, Jeffrey P. ; Smith, Craig R. ; Wechsler, Andrew. / Predictors of postoperative hematocrit and association of hematocrit with adverse outcomes for coronary artery bypass graft surgery patients with cardiopulmonary bypass. In: Journal of Cardiac Surgery. 2010 ; Vol. 25, No. 6. pp. 638-646.
@article{f5343207e5224e42b432390cc5740939,
title = "Predictors of postoperative hematocrit and association of hematocrit with adverse outcomes for coronary artery bypass graft surgery patients with cardiopulmonary bypass",
abstract = "Objective: To determine predictors of low intensive care unit (ICU) admission hematocrit, and to determine if low hematocrit is associated with postoperative outcomes for coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass. Methods: We performed a retrospective study of 8417 patients who underwent CABG surgery on cardiopulmonary bypass in New York in 2007. Patients with very low ICU admission hematocrit (≤21.9{\%}) and low ICU admission hematocrit (22.0{\%} to 25.9{\%}) were identified. Significant independent predictors of low and very low ICU admission hematocrit, and the independent impact of each of these states on adverse outcomes were identified. Results: A total of 1.1{\%} had very low hematocrit and 8.3{\%} had low hematocrit. Significant independent predictors for either low or very low hematocrit included older age, females, lower body surface area, lower ventricular function, Hispanic ethnicity, non-Caucasian race, high creatinine, previous cardiac surgery, absence of left main disease, and emergency transfer to the operating room following catheterization or percutaneous coronary intervention. Patients with hematocrit 21.9{\%} had significantly higher risk-adjusted rates of postoperative bleeding (adjusted OR = 4.37, 95{\%} CI [1.97, 9.68, respiratory failure (adjusted OR = 2.85, 95{\%} CI [1.45, 5.63]), and one or more complications than patients with normal hematocrit. Patients with hematocrit between 22.0{\%} and 25.9{\%} also had higher complication rates. Conclusion: It is important for cardiovascular surgical teams to be aware of risk factors that predispose patients to unacceptable hematocrit values, to monitor values closely, and to treat accordingly in the operating room when low values occur.",
author = "Hannan, {Edward L.} and Zaza Samadashvili and Lahey, {Stephen J.} and Culliford, {Alfred T.} and Robert Higgins and Desmond Jordan and Gold, {Jeffrey P.} and Smith, {Craig R.} and Andrew Wechsler",
year = "2010",
month = "11",
doi = "10.1111/j.1540-8191.2010.01143.x",
language = "English (US)",
volume = "25",
pages = "638--646",
journal = "Journal of Cardiac Surgery",
issn = "0886-0440",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Predictors of postoperative hematocrit and association of hematocrit with adverse outcomes for coronary artery bypass graft surgery patients with cardiopulmonary bypass

AU - Hannan, Edward L.

AU - Samadashvili, Zaza

AU - Lahey, Stephen J.

AU - Culliford, Alfred T.

AU - Higgins, Robert

AU - Jordan, Desmond

AU - Gold, Jeffrey P.

AU - Smith, Craig R.

AU - Wechsler, Andrew

PY - 2010/11

Y1 - 2010/11

N2 - Objective: To determine predictors of low intensive care unit (ICU) admission hematocrit, and to determine if low hematocrit is associated with postoperative outcomes for coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass. Methods: We performed a retrospective study of 8417 patients who underwent CABG surgery on cardiopulmonary bypass in New York in 2007. Patients with very low ICU admission hematocrit (≤21.9%) and low ICU admission hematocrit (22.0% to 25.9%) were identified. Significant independent predictors of low and very low ICU admission hematocrit, and the independent impact of each of these states on adverse outcomes were identified. Results: A total of 1.1% had very low hematocrit and 8.3% had low hematocrit. Significant independent predictors for either low or very low hematocrit included older age, females, lower body surface area, lower ventricular function, Hispanic ethnicity, non-Caucasian race, high creatinine, previous cardiac surgery, absence of left main disease, and emergency transfer to the operating room following catheterization or percutaneous coronary intervention. Patients with hematocrit 21.9% had significantly higher risk-adjusted rates of postoperative bleeding (adjusted OR = 4.37, 95% CI [1.97, 9.68, respiratory failure (adjusted OR = 2.85, 95% CI [1.45, 5.63]), and one or more complications than patients with normal hematocrit. Patients with hematocrit between 22.0% and 25.9% also had higher complication rates. Conclusion: It is important for cardiovascular surgical teams to be aware of risk factors that predispose patients to unacceptable hematocrit values, to monitor values closely, and to treat accordingly in the operating room when low values occur.

AB - Objective: To determine predictors of low intensive care unit (ICU) admission hematocrit, and to determine if low hematocrit is associated with postoperative outcomes for coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass. Methods: We performed a retrospective study of 8417 patients who underwent CABG surgery on cardiopulmonary bypass in New York in 2007. Patients with very low ICU admission hematocrit (≤21.9%) and low ICU admission hematocrit (22.0% to 25.9%) were identified. Significant independent predictors of low and very low ICU admission hematocrit, and the independent impact of each of these states on adverse outcomes were identified. Results: A total of 1.1% had very low hematocrit and 8.3% had low hematocrit. Significant independent predictors for either low or very low hematocrit included older age, females, lower body surface area, lower ventricular function, Hispanic ethnicity, non-Caucasian race, high creatinine, previous cardiac surgery, absence of left main disease, and emergency transfer to the operating room following catheterization or percutaneous coronary intervention. Patients with hematocrit 21.9% had significantly higher risk-adjusted rates of postoperative bleeding (adjusted OR = 4.37, 95% CI [1.97, 9.68, respiratory failure (adjusted OR = 2.85, 95% CI [1.45, 5.63]), and one or more complications than patients with normal hematocrit. Patients with hematocrit between 22.0% and 25.9% also had higher complication rates. Conclusion: It is important for cardiovascular surgical teams to be aware of risk factors that predispose patients to unacceptable hematocrit values, to monitor values closely, and to treat accordingly in the operating room when low values occur.

UR - http://www.scopus.com/inward/record.url?scp=78449273880&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78449273880&partnerID=8YFLogxK

U2 - 10.1111/j.1540-8191.2010.01143.x

DO - 10.1111/j.1540-8191.2010.01143.x

M3 - Article

VL - 25

SP - 638

EP - 646

JO - Journal of Cardiac Surgery

JF - Journal of Cardiac Surgery

SN - 0886-0440

IS - 6

ER -