The association of hemoglobin with postoperative delirium and atrial fibrillation after cardiac surgery: a retrospective sub-study
A associação da hemoglobina com delirium pós-operatório e fibrilação atrial após cirurgia cardíaca: um subestudo retrospectivo
Sinem Sari, Jack Brooker, Mateo Montalvo-Campana, Peter Shehata, Xuan Pu, Steven Insler, Kurt Ruetzler, Christopher A. Troianos, Alparslan Turan
Abstract
Background
Most cardiac surgery patients experience postoperative anemia. Delirium and Atrial Fibrillation (AF) are common and independent predictors of morbidity and mortality. Few reports examine their association with postoperative anemia. This study aims to quantify the association between anemia and these outcomes in patients undergoing cardiac surgery.
Methods
This post-hoc analysis of the DECADE randomized controlled trial ran at six academic US hospitals. Patients aged 18–85 years with heart rate > 50 bpm undergoing cardiac surgery who had daily hemoglobin measurements in the first 5 Postoperative Days (POD) were included. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM – ICU), preceded by the Richmond Agitation and Sedation Scale, with patients excluded from assessment if sedated. Patients had daily hemoglobin measurements, continuous cardiac monitoring plus twice-daily 12-lead electrocardiograms, up to POD4. AF was diagnosed by clinicians blinded to hemoglobin levels.
Results
Five hundred and eighty-five patients were included. Mean postoperative hemoglobin Hazard Ratio (HR): 0.99 (95% CI 0.83, 1.19; p = 0.94) per 1 g.dL−1 hemoglobin decrease. 197 (34%) developed AF, mainly on POD = 2.3. Estimated HR = 1.04 (95% CI 0.93, 1.17; p = 0.51) per 1 g.dL−1 hemoglobin decrease.
Conclusions
Most patients undergoing major cardiac surgery were anemic in the postoperative phase. AF and delirium occurred in 34% and 12% of patients, respectively, but neither were significantly correlated with postoperative hemoglobin.
Keywords
Resumo
Introdução
A maioria dos pacientes de cirurgia cardíaca apresenta anemia pós-operatória. Delirium e Fibrilação Atrial (FA) são preditores comuns e independentes de morbidade e mortalidade. Poucos relatos examinam sua associação com anemia pós-operatória. Este estudo tem como objetivo quantificar a associação entre anemia e esses desfechos em pacientes submetidos à cirurgia cardíaca.
Métodos
Esta análise post-hoc do ensaio clínico randomizado DECADE foi realizada em seis hospitais acadêmicos dos EUA. Foram incluídos pacientes com idade entre 18 e 85 anos, com frequência cardíaca > 50 bpm, submetidos à cirurgia cardíaca e que realizaram medidas diárias de hemoglobina nos primeiros 5 dias de pós-operatório (DPO). O delirium foi avaliado duas vezes ao dia pelo Confusion Assessment Method for the ICU (CAM – ICU), precedido pela Escala de Agitação e Sedação de Richmond, sendo os pacientes excluídos da avaliação se estivessem sedados. Os pacientes realizaram medições diárias de hemoglobina, monitoramento cardíaco contínuo e eletrocardiogramas de 12 derivações duas vezes ao dia, até o POD4. A FA foi diagnosticada por médicos que desconheciam os níveis de hemoglobina.
Resultados
Quinhentos e oitenta e cinco pacientes foram incluídos. Razão de risco (HR) média de hemoglobina pós-operatória: 0,99 (IC 95% 0,83; 1,19; p = 0,94) por diminuição de hemoglobina de 1 g.dL-1. 197 (34%) desenvolveram FA, principalmente no DPO = 2,3. HR estimada = 1,04 (IC 95% 0,93; 1,17; p = 0,51) por diminuição de 1 g.dL-1 de hemoglobina.
Conclusão
A maioria dos pacientes submetidos à cirurgia cardíaca de grande porte apresentou anemia no pós-operatório. FA e delirium ocorreram em 34% e 12% dos pacientes, respectivamente, mas nenhum deles foi significativamente correlacionado com a hemoglobina pós-operatória.
Palavras-chave
Referências
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Submetido em:
02/05/2022
Aceito em:
26/02/2023
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