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. 2021 Nov 1;133(5):1077-1088.
doi: 10.1213/ANE.0000000000005416.

Postoperative Hematocrit and Adverse Outcomes in Pediatric Cardiac Surgery Patients: A Cross-Sectional Study From the Society of Thoracic Surgeons and Congenital Cardiac Anesthesia Society Database Collaboration

Justin B Long  1 , Branden M Engorn  2 , Kevin D Hill  3 , Liqi Feng  4 , Karen Chiswell  4 , Marshall L Jacobs  5 , Jeffrey P Jacobs  6 , Dheeraj Goswami  7
Affiliations

Postoperative Hematocrit and Adverse Outcomes in Pediatric Cardiac Surgery Patients: A Cross-Sectional Study From the Society of Thoracic Surgeons and Congenital Cardiac Anesthesia Society Database Collaboration

Justin B Long et al. Anesth Analg. .

Abstract

Background: We sought to examine potential associations between pediatric postcardiac surgical hematocrit values and postoperative complications or mortality.

Methods: A retrospective, cross-sectional study from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and Congenital Cardiac Anesthesia Society Database Module (2014-2019) was completed. Multivariable logistic regression models, adjusting for covariates in the STS-CHSD mortality risk model, were used to assess the relationship between postoperative hematocrit and the primary outcomes of operative mortality or any major complication. Hematocrit was assessed as a continuous variable using linear splines to account for nonlinear relationships with outcomes. Operations after which the oxygen saturation is typically observed to be <92% were classified as cyanotic and ≥92% as acyanotic.

Results: In total, 27,462 index operations were included, with 4909 (17.9%) being cyanotic and 22,553 (82.1%) acyanotic. For cyanotic patients, each 5% incremental increase in hematocrit over 42% was associated with a 1.31-fold (95% confidence interval [CI], 1.10-1.55; P = .003) increase in the odds of operative mortality and a 1.22-fold (95% CI, 1.10-1.36; P < .001) increase in the odds of a major complication. For acyanotic patients, each 5% incremental increase in hematocrit >38% was associated with a 1.45-fold (95% CI, 1.28-1.65; P < .001) increase in the odds of operative mortality and a 1.21-fold (95% CI, 1.14-1.29; P < .001) increase in the odds of a major complication.

Conclusions: High hematocrit on arrival to the intensive care unit (ICU) is associated with increased operative mortality and major complications in pediatric patients following cardiac surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Comment in

References

    1. Chambers LA, Cohen DM, Davis JT. Transfusion patterns in pediatric open heart surgery. Transfusion. 1996;36:150–154.
    1. Kartha VM, Jacobs JP, Vener DF, et al. National benchmarks for proportions of patients receiving blood transfusions during pediatric and congenital heart surgery: an analysis of the STS congenital heart surgery database. Ann Thorac Surg. 2018;106:1197–1203.
    1. Ejaz A, Spolverato G, Kim Y, Frank SM, Pawlik TM. Identifying variations in blood use based on hemoglobin transfusion trigger and target among hepatopancreaticobiliary surgeons. J Am Coll Surg. 2014;219:217–228.
    1. Markham C, Small S, Hovmand P, Doctor A. Transfusion decision making in pediatric critical illness. Pediatr Clin North Am. 2017;64:991–1015.
    1. Mazine A, Rached-D’Astous S, Ducruet T, Lacroix J, Poirier N; Pediatric Acute Lung Injury and Sepsis Investigators Network. Blood transfusions after pediatric cardiac operations: a North American multicenter prospective study. Ann Thorac Surg. 2015;100:671–677.

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