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This study investigates the mediating role of intraoperative allogeneic red blood cell transfusion in the relationship between preoperative anaemia and postoperative complications in patients undergoing cardiac surgery. Using mediation analysis methods, we aim to determine whether and to what extent intraoperative transfusion explains the association between preoperative anaemia and adverse postoperative outcomes. By elucidating this pathway, the study seeks to inform perioperative blood management strategies and support more personalized, risk-adapted approaches to minimize postoperative complications in anaemic patients undergoing cardiac procedures.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| anemia |
| ||
| nonanemia |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| anemia | Other | preoperative anemia |
| |
| nonanemia |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of Postoperative Complications | The primary outcome is the occurrence of any postoperative complications during the index hospitalization. Complications include, but are not limited to, acute kidney injury (AKI), neurological complications, infections, and pulmonary complications. These are assessed using standardized diagnostic criteria. | From the start of surgery to 30 days after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of Acute Kidney Injury (AKI) | Occurrence of AKI during postoperative hospitalization, defined according to the KDIGO (Kidney Disease: Improving Global Outcomes) criteria. | From the start of surgery to 30 days after surgery |
| Incidence of Neurological Complications |
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Inclusion Criteria:
Exclusion Criteria:
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Eligible patients for inclusion were those aged 18 or older undergoing elective cardiac surgery with CPB support at West China Hospital (WCH) from 22 December 2010 to 1 July 2017, and at The Second affiliated Hospital of Zhejiang University (SAHZU) from 1 September 2013 to 31 December 2024.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine | Hangzhou | Zhejiang | 330100 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26349842 | Result | Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg. 2015 Oct;102(11):1314-24. doi: 10.1002/bjs.9861. | |
| 23647857 | Result | Horvath KA, Acker MA, Chang H, Bagiella E, Smith PK, Iribarne A, Kron IL, Lackner P, Argenziano M, Ascheim DD, Gelijns AC, Michler RE, Van Patten D, Puskas JD, O'Sullivan K, Kliniewski D, Jeffries NO, O'Gara PT, Moskowitz AJ, Blackstone EH. Blood transfusion and infection after cardiac surgery. Ann Thorac Surg. 2013 Jun;95(6):2194-201. doi: 10.1016/j.athoracsur.2012.11.078. Epub 2013 May 3. |
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| ID | Term |
|---|---|
| D000740 | Anemia |
| D017008 | Negotiating |
| ID | Term |
|---|---|
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D003142 | Communication |
| D001519 | Behavior |
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| Other |
preoperative nonanemia |
|
Occurrence of neurological complications such as postoperative delirium, stroke, or cognitive dysfunction, assessed based on clinical diagnosis and relevant neurocognitive evaluation. |
| From the start of surgery to 30 days after surgery |
| Incidence of Infections | Occurrence of postoperative infections including surgical site infection, bloodstream infection, and pneumonia, diagnosed according to CDC criteria. | From the start of surgery to 30 days after surgery |
| Incidence of Pulmonary Complications | Occurrence of pulmonary complications including pneumonia, pleural effusion, atelectasis, or need for prolonged mechanical ventilation (>48 hours postoperatively). | From the start of surgery to 30 days after surgery |
| Length of Hospital Stay | Duration of postoperative hospital stay, defined as the number of days from the date of surgery to the date of hospital discharge. | From the start of surgery to 30 days after surgery |
| Total Hospitalization Cost | Total direct medical cost incurred during the index hospitalization, including surgical costs, intensive care, ward care, medications, laboratory and imaging studies, and blood transfusion-related expenses. | From the start of surgery to 30 days after surgery |
| 31702696 | Result | Transfusion of Red Blood Cells, Fresh Frozen Plasma, or Platelets Is Associated With Mortality and Infection After Cardiac Surgery in a Dose-Dependent Manner. Anesth Analg. 2020 Feb;130(2):e32. doi: 10.1213/ANE.0000000000004528. |