• Fehmi Kattou, Olivier Montandrau, Mohamed Rekik, Philippe Delentdecker, Kais Brini, Konstantinos Zannis, and Marc Beaussier.
• Department of Anesthesia and Intensive Care, Institut Mutualiste Montsouris, Paris, France.
• J. Cardiothorac. Vasc. Anesth. 2022 Jul 1; 36 (7): 1901-1907.

ObjectivesPreoperative anemia is frequent in patients undergoing cardiac surgery and is associated with increased postoperative complications. The purpose of this observational study was to estimate the critical preoperative hemoglobin threshold associated with the occurrence of complications after cardiac surgery.DesignA retrospective observational cohort study.SettingA tertiary-care medical center from January 2019 to April 2020.ParticipantsA total of 1,004 patients undergoing elective cardiac surgery were included.InterventionsNone (observational study).Measurements And Main ResultsThe primary study endpoint was to define the hemoglobin threshold that predicted the occurrence of postoperative major complications after elective cardiac surgery. Postoperative complications were a composite criterion, including transient ischemic attack or stroke, myocardial infarction, acute kidney injury, respiratory failure, mediastinitis, or mesenteric ischemia. A discrimination threshold was determined by using receiver operating characteristic curves. The discrimination threshold for hemoglobin concentration with the best sensitivity/specificity ratio for the occurrence of postoperative complications was 13 g/dL for male patients and 11.8 g/dL for female patients. The incidence of postoperative complications was 17.2% in the total population. Independent risks were preoperative hemoglobin concentration, red blood cell transfusion, European System for Cardiac Operative Risk Evaluation II, and the type of surgery.ConclusionsThe critical preoperative hemoglobin thresholds associated with the occurrence of postoperative complications with the best sensitivity/specificity ratio were 13 g/dL for men and 11.8 g/dL for women, which were very similar to the World Health Organization criteria defining anemia.Copyright © 2022 Elsevier Inc. All rights reserved.

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