Intraoperative hemoglobin levels and transfusion independently predict stroke after cardiac operations

Zainab S. Bahrainwala, Maura A. Grega, Charles W. Hogue, William A. Baumgartner, Ola A. Selnes, Guy M. McKhann, Rebecca F. Gottesman

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Background: Anemia has been associated with adverse cerebrovascular outcomes, particularly after cardiac operations. This study was conducted to determine if hemoglobin levels during and after cardiopulmonary bypass (CPB) predict postoperative stroke in cardiac surgical patients, independent of transfusion requirements. Methods: Individuals who had sustained a clinical postoperative stroke (cases) were matched 1:2 with controls by age, sex, surgical procedure, and year of operation. In 617 patients, conditional logistic regression was performed to analyze associations between hemoglobin levels before and after CPB, and stroke. Results: After adjustment for potentially confounding vascular risk factors, lower hemoglobin after CPB was associated with a higher risk of stroke, even after adjustment for the amount of packed red blood cells transfused (adjusted odds ratio, 1.28; 95% confidence interval, 1.00 to 1.64, per point of lower hemoglobin level; adjusted odds ratio for stroke per higher quartile of packed red blood cells transfused in this model, 1.37; 95% confidence interval, 1.02 to 1.83). Similar associations were not found for hemoglobin concentrations preoperatively nor change in hemoglobin from before to after CPB. A post-CPB hemoglobin level below the median was associated with 37% increased odds of a postoperative stroke occurring (p = 0.02). Conclusions: Lower postoperative hemoglobin levels and higher intraoperative transfusion requirements are each independently associated with a higher risk of stroke. Reduced cerebral oxygen delivery due to anemia may contribute to cerebral injury after coronary artery bypass grafting.

Original languageEnglish (US)
Pages (from-to)1113-1118
Number of pages6
JournalAnnals of Thoracic Surgery
Issue number4
StatePublished - Apr 2011

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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