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Journal Article Epublish 17 citations

PubMed: 33626048 DOI: 10.1371/journal.pone.0241114

Intraoperative blood loss may be associated with myocardial injury after non-cardiac surgery.

PLoS One 16(2):e0241114

Authors: Jungchan Park, Ji-Hye Kwon, Seung-Hwa Lee, Jong Hwan Lee, Jeong Jin Min, Jihoon Kim, Ah Ran Oh, Wonho Seo, Cheol Won Hyeon, Kwangmo Yang, Jin-Ho Choi, Sang-Chol Lee, Kyunga Kim, Joonghyun Ahn, Hyeon-Cheol Gwon

Affiliations

  • Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
  • Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea. Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea.
  • Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea.

Abstract

BACKGROUND

This study aimed to evaluate the association between intraoperative blood loss and myocardial injury after non-cardiac surgery (MINS), which is a severe and common postoperative complication.

METHODS

We compared the incidence of MINS based on significant intraoperative bleeding, defined as an absolute hemoglobin level < 7 g/dL, a relative hemoglobin level less than 50% of the preoperative measurement, or need for packed red cell transfusion. We also estimated a threshold for intraoperative hemoglobin level associated with MINS.

RESULTS

We stratified a total of 15,926 non-cardiac surgical patients with intraoperative hemoglobin and postoperative cardiac troponin (cTn) measurements according to the occurrence of significant intraoperative bleeding; 13,416 (84.2%) had no significant bleeding while 2,510 (15.8%) did have significant bleeding. After an adjustment with inverse probability weighting, the incidence of MINS was higher in the significant bleeding group (35.2% vs. 16.4%; odds ratio, 1.58; 95% confidence interval, 1.43-1.75; p < 0.001). The threshold of intraoperative hemoglobin associated with MINS was estimated to be 9.9 g/dL with an area under the curve of 0.643.

CONCLUSION

Intraoperative blood loss appeared to be associated with MINS. Further studies are needed to confirm these findings.

CLINICAL REGISTRATION

The cohort was registered before patient enrollment at https://cris.nih.go.kr (KCT0004244).

MeSH

Incidence, Research Design, Hemorrhage, Blood, Hemoglobins

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