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An update on mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion (CME)
Author(s) -
Shander Aryeh,
Javidroozi Mazyar,
Naqvi Sajjad,
Aregbeyen Oshuare,
Çaylan Mustafa,
Demir Selma,
Juhl Anna
Publication year - 2014
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12565
Subject(s) - medicine , odds ratio , sepsis , confidence interval , myocardial infarction , blood transfusion , retrospective cohort study , anemia , mortality rate , pneumonia , surgery , blood management , heart failure
Background Severely anemic patients for whom blood transfusion is not an option provide highly valuable information on risks of anemia and alternative management strategies. Study Design and Methods This is a retrospective study of consecutive patients at least 18 years old who could not be transfused, had surgery at a patient blood management center between 2003 and 2012, and had at least one hemoglobin ( Hb ) measurement of not more than 8 g/ dL during the postoperative period. The primary outcome measure was mortality, occurring anytime in the period after the surgery until discharge or 30th day after the surgery, whichever was sooner. Postoperative morbidities included the occurrence of any of sepsis, pneumonia, myocardial infarction, deep wound infection, congestive heart failure, and arrhythmia. Results A total of 293 patients (including 288 who self‐identified as “ J ehovah's W itness”) were eligible and enrolled. The mean ± SD age of the patients was 61.5 ± 16.9 years and 74.1% were female. Overall mortality rate was 8.2% (95% confidence interval [ CI ], 5%‐11.3%). Unadjusted odds ratio ( OR ) of death per each 1 g/d L decrease in the nadir postoperative H b was 2.04 (95% CI , 1.52‐2.74); OR of death after adjustment for other significant factors (urgency, A merican S ociety of A nesthesiology score, and age) was 1.82 (95% CI , 1.27‐2.59). Conclusion Our study confirms the previously reported low risk of mortality in upper nadir Hb ranges of 7 to 8 g/ dL and much higher risk in lower ranges, albeit the number of patients reaching extremely low Hb levels were lower than previous report, possibly suggestive of improved management strategy of these patients.