The association of hemoglobin with postoperative delirium and atrial fibrillation after cardiac surgery: a retrospective sub-study
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
References
- 1
How Many Cardiac Surgeries Are Performed Each Year? ‒ New Study by iData Research ‒ iData Research [Internet]. [cited 2022 Jun 2]. Available from: https://idataresearch.com/over-900000-cardiac-surgeries-performed-every-year-in-the-united-states/.
- 2
Atrial fibrillation after cardiac surgeryAnn Intern Med, 135 (2001), pp. 1061-1073
- 3
The elderly surgical patient and postoperative deliriumJ Am Coll Surg, 203 (2006), pp. 752-757
- 4
Cytokines and C-reactive protein production in hip-fracture-operated elderly patientsJ Gerontol A Biol Sci Med Sci, 62 (2007), pp. 420-426
- 5
Postoperative delirium and cognitive dysfunctionBr J Anaesth, 103 (2009), pp. i41-i46Suppl 1
- 6
Postoperative anaemia might be a risk factor for postoperative delirium and prolonged hospital stay: A secondary analysis of a prospective cohort studyPLoS One, 15 (2020), Article e0229325
- 7
Preanesthetic evaluation of the female geriatric patient with hip fractureActa Anaesthesiol Scand, 26 (1982), pp. 393-402
- 8
Prevalence and outcomes of anemia in surgery: a systematic review of the literatureAm J Med, 116 (2004), pp. 58-69Suppl 7A(7 SUPPL. 1)
- 9
Perioperative anemia: Prevalence, consequences, and pathophysiologyTransfus Apher Sci, 58 (2019), pp. 369-374
- 10
Meta-analysis of the association between preoperative anaemia and mortality after surgeryBr J Surg, 102 (2015), pp. 1314-1324
- 11
Hazards of postoperative atrial arrhythmiasAnn Thorac Surg, 56 (1993), pp. 539-549
- 12
Postoperative Atrial Fibrillation: Incidence, Mechanisms, and Clinical CorrelatesHeart Fail Clin, 12 (2016), pp. 299-308
- 13
Postoperative atrial fibrillation and mortality after coronary artery bypass surgeryJ Am Coll Cardiol, 43 (2004), pp. 742-748
- 14
Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resourcesCirculation, 94 (1996), pp. 390-397
- 15
Persistent atrial activity during cardioplegic arrest: a possible factor in the etiology of postoperative supraventricular tachyarrhythmiasAnn Thorac Surg, 36 (1983), pp. 437-443
- 16
Atrial fibrillation after cardiac surgery: pathophysiology and treatmentSemin Cardiothorac Vasc Anesth, 8 (2004), pp. 175-183
- 17
Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): a randomised placebo-controlled trialLancet, 396 (2020), pp. 177-185
- 18
The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patientsAm J Respir Crit Care Med, 166 (2002), pp. 1338-1344
- 19
Validation of a Nurse-Based Delirium-Screening Tool for Hospitalized PatientsPsychosomatics, 58 (2017), pp. 594-603
- 20
The Effects of Blood Transfusion on Delirium IncidenceJ Am Med Dir Assoc, 17 (2016), pp. 748-753
- 21
Association between intraoperative blood transfusions and early postoperative delirium in older adultsJ Am Geriatr Soc, 61 (2013), pp. 365-370
- 22
The relationship between perioperative blood transfusion and postoperative delirium in patients undergoing spinal fusion surgery: Clinical Data Warehouse AnalysisMedicina (Kaunas), 58 (2022), p. 268
- 23
Blood transfusion and the risk of atrial fibrillation after cardiac surgeryJ Card Surg, 29 (2014), pp. 593-599
- 24
Blood transfusion and risk of atrial fibrillation after coronary artery bypass graft surgery: A meta-analysis of cohort studiesMedicine, 97 (2018), p. e9700
- 25
Haematological indices as predictors of atrial fibrillation following isolated coronary artery bypass grafting, valvular surgery, or combined procedures: a systematic review with meta-analysisKardiol Pol, 76 (2018), pp. 107-118
- 26
Biochemical predictors of postoperative atrial fibrillation following cardiac surgeryBMC Cardiovasc Disord, 21 (2021), p. 167
- 27
Supraventricular tachyarrhythmias in hospitalized adults after surgery. Clinical correlates in patients over 40 years of age after major noncardiac surgeryChest, 73 (1978), pp. 450-454
- 28
Clinical relationship between anemia and atrial fibrillation recurrence after catheter ablation without genetic backgroundInt J Cardiol Heart Vasc, 27 (2020), Article 100507
- 29
Clinical risk factors for postoperative atrial fibrillation among patients after cardiac surgeryThorac Cardiovasc Surg, 67 (2019), pp. 107-116
- 30
Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgeryCoron Artery Dis, 7 (1996), pp. 475-478
- 31
Postoperative atrial fibrillationISRN Cardiol., 2011 (2011), Article 203179