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Cited by 51Blood transfusion and managementIron Metabolism and DisordersCardiac and Coronary Surgery Techniques

Postoperative outcomes following cardiac surgery in non-anaemic iron-replete and iron-deficient patients—An exploratory study

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Miles, L. F., Kunz, S. A., Na, L. H., Braat, S., Burbury, K., Story, D. A.·2018·Anaesthesia
DOI 10.1111/anae.14115
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Abstract

Summary: Iron deficiency anaemia is strongly associated with poor outcomes after cardiac surgery. However, pre‐operative non‐anaemic iron deficiency (a probable anaemia precursor) has not been comprehensively examined in patients undergoing cardiac surgery, despite biological plausibility and evidence from other patient populations of negative effect on outcome. This exploratory retrospective cohort study aimed to compare an iron‐deficient group of patients undergoing cardiac surgery with an iron‐replete group. Consecutive non‐anaemic patients undergoing elective coronary artery bypass grafting or single valve replacement in our institution between January 2013 and December 2015 were considered for inclusion. Data from a total of 277 patients were analysed, and were categorised by iron status and blood haemoglobin concentration into iron‐deficient (n = 109) and iron‐replete (n = 168) groups. Compared with the iron‐replete group, patients in the iron‐deficient group were more likely to be female (43% vs. 12%, iron‐replete, respectively); older, mean (SD) age 64.4 (9.7) vs. 63.2 (10.3) years; and to have a higher pre‐operative EuroSCORE (median IQR [range]) 3 (2–5 [0–10]) vs. 3 (2–4 [0–9]), with a lower preoperative haemoglobin of 141.6 (11.6) vs. 148.3 (11.7) g.l −1 . Univariate analysis suggested that iron‐deficient patients had a longer hospital length of stay (7 (6–9 [2–40]) vs. 7 (5–8 [4–23]) days; p = 0.013) and fewer days alive and out of hospital at postoperative day 90 (83 (80–84 [0–87]) vs. 83 (81–85 [34–86]), p = 0.009). There was no evidence of an association between iron deficiency and either lower nadir haemoglobin or higher requirement for blood products during inpatient stay. After adjusting the model for pre‐operative age, sex, renal function, Euro SCORE and haemoglobin, the mean increase in hospital length of stay in the iron‐deficient group relative to the iron‐replete group was 0.86 days (bootstrapped 95%CI −0.37 to 2.22, p = 0.098). This exploratory study suggests there is weak evidence of an association between non‐anaemic iron deficiency and outcome after cardiac surgery after controlling for potentially confounding variables.

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  • NAID is a disease in its own right and warrants attention due to the potential danger it poses for patients (e.g., transfusion requirement and a high rate of morbidity and mortality), especially those who undergo major surgical procedures.

    “It is worth paying attention to the evidence that NAID is a disease in its own right and warrants attention due to the potential danger it poses for patients (e.g., transfusion requirement and a high rate of morbidity and mortality), especially those who undergo major surgical procedures [31,32,33,34,35].”

    From Defining Global Thresholds for Serum Ferritin: A Challenging Mission in Establishing the Iron Deficiency Diagnosis in This Era of Striving for Health Equity (2025) · cites this paper as [33]

    The Methods report longer hospital stays and fewer days alive and out of hospital at day 90 among non-anaemic iron-deficient cardiac-surgery patients. They found no significant difference in transfusion or mortality, however, and the Discussion describes the evidence after adjustment as weak. The paper does not establish that NAID is a disease in its own right or causes the high morbidity and mortality claimed. Page numbers were not available in our copy. (LLM, conf=0.88)

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  20. [27]27. Muñoz M, Laso-Morales MJ, Gómez-Ramírez S, Cadellas M, Núñez -Matas MJ, García -Erce JA. Pre-operative haemoglobin levels and iron status in a large multicentre cohort of patients undergoing major elective surgery. ePub ahead of print Anaesthesia 2017; Apr 6: doi:10.1111/anae.13840. <!-- image --> anae\_14115\_f2.png <!-- image --> anae\_14115\_f3.png <!-- image --> · DOI · Paper page

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Authors
Miles, L. F., Kunz, S. A., Na, L. H., Braat, S., Burbury, K., & Story, D. A.
Affiliations
The University of Melbourne (AU)
Corresponding author
Miles, L. F.
ORCID
Venue
Anaesthesia
Publisher
Wiley
Published
2017-12-02
Volume
73
Issue
4
Pages
450-458
ISSN
  • 0003-2409 (ISSN-L)
  • 1365-2044
DOI
10.1111/anae.14115
OpenAlex
W2775435138
Cited by
51
References
22
Citations by year
2026: 3 · 2025: 5 · 2024: 5 · 2023: 3 · 2022: 13 · 2021: 4 · 2020: 7 · 2019: 8 · 2018: 2 · 2017: 1
FWCI
3.07
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Anaesthesia (publishedVersion)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
Topics
  • Health Sciences › Medicine › Biochemistry › Blood transfusion and management
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Keywords
iron deficiency, cardiac surgery, coronary artery bypass grafting, valve replacement, postoperative outcomes, length of hospital stay, mortality, hemoglobin, blood transfusion, iron status, EuroSCORE, blood products, sex differences, age differences, renal function, preoperative hemoglobin, postoperative complications, postoperative delirium
MeSH terms
Iron Deficiencies, Aged, Coronary Artery Bypass, Australia, Female, Cardiac Surgical Procedures, Humans, Length of Stay, Male, Middle Aged, Missouri, New Zealand, Postoperative Complications, Retrospective Studies, Databases, Factual, Treatment Outcome, Heart Valve Prosthesis Implantation

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