Abstract
Association of preoperative anemia and blood transfusion with long-term survival after coronary artery bypass grafting
Department of Cardiac Surgery, Zbigniew Religa Heart Center “Medinet”, Nowa Sol, Poland
Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Poland
Doctoral School of Exact and Technical Sciences, University of Zielona Gora, Poland
Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
Kardiochirurgia i Torakochirurgia Polska 2026; 23 (3): 203-212
Introduction
Preoperative anemia is a known risk factor for adverse surgical outcomes, including increased morbidity and mortality. Blood transfusion, though often necessary, may contribute to immunomodulation and complications.
Aim
This study evaluated the associations of preoperative anemia and perioperative blood transfusion with long-term survival in patients following coronary artery bypass grafting (CABG), considering pre-, intra-, and postoperative factors.
Material and methods
We retrospectively analyzed 1458 patients undergoing consecutive isolated CABG between November 2014 and December 2020 at a single institution. Of these patients, 18.1% had preoperative anemia and 44.5% received perioperative packed red blood cell transfusion (pRBC). Among patients with preoperative anemia, the majority had mild anemia (79.1%). Propensity scores (PS) were generated separately for patients with and without preoperative anemia and for patients with and without pRBC. PS were generated from a multivariable logistic regression model based on preoperative, operative, and postoperative variables. Patients were then matched in 1 : 1 fashion using a caliper matching method without replacement with a caliper width of 0.2 standard deviations of the logit of the PS. The balance of the covariates was tested using standardized mean difference (SMD). PS matching resulted in 244 well-balanced pairs of patients with and without preoperative anemia and 355 well-balanced pairs of patients with and without pRBC.
Results
Median follow-up was 5.42 years (interquartile range: 3.82–7.27). In the matched cohorts, preoperative anemia was associated with increased long-term mortality compared to patients without preoperative anemia (HR stratified on matched pairs: 1.56, 95% CI: 1.04–2.33; p = 0.029), while perioperative pRBC transfusion did not significantly impact long-term survival compared to patients who did not receive pRBC (HR stratified on matched pairs: 0.92, 95% CI: 0.63–1.35; p = 0.70).
Conclusions
Preoperative anemia was associated with long-term mortality in patients undergoing CABG. On the other hand, perioperative blood transfusion, while necessary in some cases, was not associated with worse survival.
Keywords
coronary artery bypass grafting, preoperative anemia, blood transfusion, patient blood management
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