May 2002

From Lancet

Substantial increase in death rate after bypass surgery for people with anaemia

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Anaemic patients undergoing coronary artery bypass surgery could have up to a five-fold increased risk of death in the days after surgery compared with patients who have normal haemoglobin concentrations, suggest authors of a research letter in this week's issue of THE LANCET.

People with anaemia (individuals with a haemoglobin concentration of less than 100 g per litre) are frequently given a blood transfusion before any major operation. However, results of research suggest that such concentrations are well tolerated during various types of surgery, negating the need for transfusion. Individuals with coronary artery disease are less tolerant to anaemia when undergoing non-cardiac surgery than patients with no evidence of coronary artery disease. Researchers from Imperial College School of Science, Technology, and Medicine, London, UK, did an observational study in 2059 patients undergoing coronary artery bypass surgery to assess the effect of haemoglobin concentration on in-hospital death.

The investigators report that individuals with anaemia before surgery had a five-fold higher in-hospital mortality rate after surgery than those with a higher haemoglobin concentration. This occurred despite these patients having had blood transfusions or the pump primed with blood preoperatively as a routine precaution.

Jens Peder Bagger (one of the investigators) comments: "Since correction of anaemia around the time of surgery did not improve survival rate, our findings suggest that patients who present with anaemia should be further investigated before surgery whenever possible."

Contact: Dr Jens Peder Bagger, Cardiothoracic Directorate, Faculty of Medicine, Imperial College School of Science, Technology and Medicine, Hammersmith Hospital, London W12 0NN, UK; T) +44 (0)20 8383 3171; F) +44 (0)20 8740 8373; E) p.bagger@ic.ac.uk











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