Preoperative Anemia Correction in Cardiac Surgery: A Propensity-Matched Study

•Question: Does preoperative correction of anemia decrease allogeneic blood transfusion rate?•Findings: A tailored treatment with ferric carboxymaltose and/or erythropoietin decreased red blood cell transfusion rate by 20%•Meaning: Preoperative anemia should be corrected with tailored treatment, based on the nature of anemia, to limit the need for allogeneic blood transfusion.Objective: Preoperative anemia is a risk factor for transfusions, morbidity, and mortality in cardiac surgery. The aim of this study was to assess if an anemia intervention strategy before cardiac surgery is associated with reduced red blood cell (RBC) transfusion. Design: Retrospective, propensity-matched study. Setting: University clinical research hospital. Participants: A total of 228 adult cardiac surgery patients. Propensity matching was based on demographics, pretreatment hemoglobin value, congestive heart failure, active endocarditis, serum creatinine, serum bilirubin, redo surgery, nonelective surgery, and nonisolated surgery. Interventions: Patients in the treated group received an anemia correction treatment at the pre-admission anesthesia clinic examination. The treatment included ferric carboxymaltose and/or erythropoietin based on the anemia diagnosis (absolute sideropenic, functional sideropenic, anemia of chronic disease). Treatment was single shot, at a median of 13 preoperative days (interquartile range, 9-17 days). Patients in the control group were selected by propensity matching and did not receive any treatment. Measurements and Main Results: Patients in the treated group received RBC transfusion in 61.4% of the cases versus 76.3% in the control group (odds ratio 0.49, 95% confidence interval 0.26-0.84, p = 0.010) and a median units load of 1 unit (interquartile range, 0-2) versus 2 units (interquartile range, 1-3) in the control group (p = 0.001). Patients in the treated group had significantly lower chest drain output, postoperative low cardiac output rate, and shorter intensive care and hospital stay. Conclusions: Anemia correction before cardiac surgery is associated with a reduction in both the RBC transfusion rate and the amount of units transfused.