Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 26.
doi: 10.1111/anae.16753. Online ahead of print.

Associations between persistent postoperative anaemia and mortality 1 year after valvular heart surgery: a retrospective cohort study

Hee Won Choi  1 , Hyun-Soo Zhang  2 , Jae-Kwang Shim  1   3 , Jin Sun Cho  1   3 , Seo Hee Ko  1   3 , Young Lan Kwak  1   3
Affiliations

Associations between persistent postoperative anaemia and mortality 1 year after valvular heart surgery: a retrospective cohort study

Hee Won Choi et al. Anaesthesia. .

Abstract

Introduction: Peri-operative anaemia is a common problem in patients undergoing cardiac surgery. Postoperative anaemia is not well understood relative to pre-operative anaemia; limited data exist on haemoglobin recovery and mortality after discharge, especially in the era of restrictive transfusion practice. We aimed to investigate the associations of pre-operative and persistent postoperative anaemia with 1-year mortality in patients undergoing valvular heart surgery.

Methods: We identified patients who had undergone valvular heart surgery and allocated them to one of four groups based on their pre-operative (haemoglobin ≥ 130 g.l-1 and < 130 g.l-1 in men and ≥ 120 g.l-1 and < 120 g.l-1 in women) and postoperative (measured 2 months after surgery; haemoglobin ≥ 100 g.l-1 and < 100 g.l-1 in both men and women) anaemia status. The four groups were: pre- and postoperative non-anaemia (non-anaemia-non-anaemia); pre-operative anaemia-postoperative non-anaemia (anaemia-non-anaemia); pre- and postoperative anaemia (anaemia-anaemia); and pre-operative non-anaemia-postoperative anaemia (non-anaemia-anaemia). The primary outcome was 1-year mortality.

Results: Data from 2486 patients were included. Pre-operative anaemia was diagnosed in 1107 patients (44.5%) and 279 (11.9%) met the diagnostic criteria for persistent anaemia 2 months postoperatively. The overall 1-year mortality rate was 3.3%. The highest rate was observed in the anaemia-anaemia group (17.8%), followed by the non-anaemia-anaemia (13.1%), anaemia-non-anaemia (2.9%) and non-anaemia-non-anaemia (0.5%) groups. Multivariable Cox regression analysis showed that the non-anaemia-anaemia group had the highest risk of 1-year mortality (adjusted hazard ratio 14.44, 95%CI 4.88-42.69), followed by the anaemia-anaemia group (adjusted hazard ratio 10.94, 95%CI 4.41-27.16).

Discussion: Our study highlights the high prevalence of persistent anaemia following valvular heart surgery. Persistent anaemia 2 months postoperatively is associated with an increased risk of 1-year mortality.

Keywords: anaemia; cardiac surgery; haemoglobin; mortality.

Plain language summary

People who have heart surgery often have low levels of red blood cells (called anaemia). Doctors know a lot about anaemia before surgery, but not as much about what happens after. We wanted to learn if having anaemia before and after heart valve surgery affects a person's chance of dying within a year after the surgery. We looked at people who had heart valve surgery. We put them into four groups based on their blood levels before and two months after surgery: 1. No anaemia before or after surgery; 2. Anaemia before surgery but not after; 3. Anaemia before and after surgery; and 4. No anaemia before surgery but anaemia after. We checked how many people in each group died within one year. We studied 2,486 people. About 45% had anaemia before surgery, and about 12% still had it two months after surgery. The overall number of people who died within a year was low (3.3%), but the highest number of deaths happened in: people who had anaemia both before and after surgery (17.8% died); and people who had no anaemia before but had it after surgery (13.1%). Many people still have anaemia two months after heart valve surgery. This is linked to a higher chance of dying within a year. It's important for doctors to watch blood levels after surgery and find ways to help people recover.

PubMed Disclaimer

References

    1. Ranucci M, Baryshnikova E, Castelvecchio S, Pelissero G. Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thorac Surg 2013; 96: 478–485. https://doi.org/10.1016/j.athoracsur.2013.03.015.
    1. Hung M, Besser M, Sharples LD, Nair SK, Klein AA. The prevalence and association with transfusion, intensive care unit stay and mortality of pre‐operative anaemia in a cohort of cardiac surgery patients. Anaesthesia 2011; 66: 812–818. https://doi.org/10.1111/j.1365‐2044.2011.06819.x.
    1. Padmanabhan H, Siau K, Curtis J, Ng A, Menon S, Luckraz H, Brookes MJ. Preoperative anemia and outcomes in cardiovascular surgery: systematic review and meta‐analysis. Ann Thorac Surg 2019; 108: 1840–1848. https://doi.org/10.1016/j.athoracsur.2019.04.108.
    1. Hazen Y, Noordzij PG, Gerritse BM, et al. Preoperative anaemia and outcome after elective cardiac surgery: a dutch national registry analysis. Br J Anaesth 2022; 128: 636–643. https://doi.org/10.1016/j.bja.2021.12.016.
    1. Huang J, Firestone S, Moffatt‐Bruce S, Tibi P, Shore‐Lesserson L. 2021 clinical practice guidelines for anesthesiologists on patient blood management in cardiac surgery. J Cardiothorac Vasc Anesth 2021; 35: 3493–3495. https://doi.org/10.1053/j.jvca.2021.09.032.

LinkOut - more resources