Preoperative Hemoglobin Level, Oxygen Saturation and Postoperative Outcomes in Children With Cyanotic Congenital Heart Disease: A Propensity-Score Matching Analysis

Abstract

BackgroundThe optimal preoperative hemoglobin (Hb) level is difficult to define in children with cyanotic congenital heart disease (CHD) due to hypoxemia-induced secondary erythrocytosis. This retrospective study integrated preoperative Hb and pulse oxygen saturation (SpO2) using the product of Hb × SpO2 to predict postoperative outcomes in children with cyanotic CHD.Patients and MethodsChildren aged <18 years undergoing cardiac surgery with cyanotic CHD were included. The cutoff value of Hb × SpO2 was the age-adjusted lower limit of normal Hb (aaHb) in healthy children. The main outcomes were in-hospital death and the composite outcome of severe postoperative events. Multivariate logistic regression analysis and propensity score matching analysis were used to adjust for important confounders.ResultsThe presence of preoperative Hb × SpO2 < aaHb was observed in 21.6% of cyanotic children (n = 777). Children with Hb × SpO2 < aaHb had higher in-hospital mortality (12.5% vs. 4.6%, P < 0.001) and composite outcome incidence (69.6% vs. 32.3%, P < 0.001) than those with Hb × SpO2 ≥ aaHb. After propensity score matching, 141 pairs of children were successfully matched. Multivariate analysis showed that preoperative Hb × SpO2 < aaHb was significantly associated with the composite outcome in the entire population (odds ratio = 4.092, 95% confidence interval = 2.748–6.095, P < 0.001) and the matched cohorts (odds ratio = 2.277, 95% confidence interval = 1.366–3.795, P = 0.002).ConclusionOur results suggest that a preoperative Hb × SpO2 value below the lower limit of normal hemoglobin is a prognostic factor in cyanotic children undergoing cardiac surgery and is a potential criterion to evaluate preoperative anemia in this population.

A Model to Predict in-Hospital Death in Patients with Type B Acute Aortic Dissection: A Single-Center Retrospective Observational Study

“…HB could combine with oxygen to transport oxygen, and there is a relationship between hypoxia in skeletal muscle [Tseng 2021]. Previous researchers have reported that admission HB was related to many diseases, such as acute ischemic stroke, cyanotic congenital heart disease, and gestational diabetes [Liu 2022;Zhou 2021;Sissala 2022]. In this study, a significant difference also was found between survivors and nonsurvivors.…”

Preoperative hematocrit levels and postoperative mortality in patients undergoing craniotomy for brain tumors

“…Numerous limitations require consideration in this study. The retrospective design poses challenges in confirming direct causality and is susceptible to predisposition from unobserved variables like oxygen saturation and chronic hypoxemia, such as obstructive sleep apnea, heart disease, or obesity hypoventilation syndrome, which might have influenced our findings ( 26 , 28 , 29 ). Second, our hospital data could not capture the reason for anemia or polycythemia.…”