Keywords• allogeneic blood transfusion • cardiac surgery • postoperative outcome • preoperative anemia S U M M A R YPreoperative anemia in patients undergoing cardiac surgery is associated with a higher transfusion risk and poorer outcomes. This retrospective study was undertaken to assess the prevalence of preoperative anemia and its associated risk factors, as well as its influence on postoperative outcomes, in 576 patients undergoing elective cardiac surgery (52.3% with cardiopulmonary bypass) for myocardial revascularization, valve replacement, coronary + valve, or miscellaneous pathology at a single institution. Perioperative data were reviewed according to the presence or absence of preoperative anemia (hemoglobin < 13 g/dL for men, hemoglobin < 12 g/dL for women). Overall, 210 patients (36.5%) presented with anemia. Logistic regression analysis revealed that age, chronic kidney disease, and consumption of proton pump inhibitors histamine H 2 receptor antagonists and diuretics were independent risk factors for the presence of preoperative anemia. Postoperatively, anemic patients received transfusions and inotropic support and stayed longer than 4 days in the recovery unit more frequently than non-anemic patients, but there were no differences in the composite outcome variable (stroke, myocardial infarction, renal failure or death). In conclusion, our data seem to indicate that preoperative anemia has a high prevalence among elective cardiac surgical patients and increases postoperative morbidity. Therefore, we need to address two specific areas about preoperative anemia in these patients: early recognition and evaluation, and appropriate and timely treatment.

Critical Care Medicine www.ccmjournal.org e689 relative risk, 0.83 [95% CI, 0.62-1.11]) and transfused RBC units (1.5 ± 1.4 U/patient vs to 1.0 ± 0.1 U/patient; p < 0.05), with no differences in the occurrence of adverse effects reported during 1-year follow-up. This controlled trial suggested that RBCT could be guided by noninvasive cerebral oxygenation monitoring, since increasing hemoglobin concentration in the absence of tissue hypoxia may not result in any benefit. The findings of Bogossian et al (1) reinforces the value of tissue oxygenation variables for guiding RBCTs in neurocritical patients.

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