TITLE:
Prevalence of Preoperative Anemia in Elective Rheumatic Valve Surgery at a Tertiary Care Center in Nepal
AUTHORS:
Priska Bastola, Bibhush Shrestha, Bishwas Pradhan, Arjun Gurung, Basanta Ghimire, Anil Bhattarai
KEYWORDS:
Anemia, Rheumatic Heart Disease, Elective Valve Surgery, Blood Transfusion
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.13 No.1,
January
18,
2023
ABSTRACT: Background: Rheumatic Valvular Heart disease (RVHD) is common
in developing countries often associated with anemia; however its burden is
often overlooked. Anemic patients undergoing surgery are likely to receive
blood transfusion, increasing morbidity and mortality. Prevalence of anemia in
cardiac surgical patients are studied extensively, however its burden in RVHD is lacking. This study attempted to investigate the
prevalence of preoperative anemia in RVHD and its effect on blood transfusion,
morbidity and mortality in patients undergoing valve surgery. Methods: This
is a retrospective observational study conducted at a tertiary care hospital in
Nepal. We considered 340 patients who underwent Rheumatic valve replacement
surgery from 2014 January to December 2016 and data on their socio-demographic
and clinical characteristics were extracted from the patient’s records. The analyses meeting the study objectives
were conducted using IBM SPSS v25 for Windows (IBM Statistical Package for Social Sciences, 2015IBM Corporation, New York, United States). Results: The prevalence of no anemia, mild, moderate,
and severe anemia was 34.1%, 57.7%, 39.6%, 2.5%, respectively. The units of Red
Blood Cell used for transfusion were 1.2 units, 2.0 units, 2.3 units, and 1.6 units in
patients without anemia, and those with mild, moderate and severe anemia respectively. The incidence of reexploration was higher in
patients with severe anemia as compared to
the non anemic with an incidence of 66.6%. A proportion of the patients with no anemia, mild,
moderate and severe anemia with less than 7 days stay in the intensive care
unit were 89%, 82%, 84.7% and 100% respectively.
The length of hospital stay more than 10 days was seen in 58.9%, 71.6%,
63% and 100% in patients with no anemia, mild,
moderate and severe anemia. An overall incidence of mortality in anemic
patients was 11% while in non anemic patients was 5.3%. Conclusions: The prevalence of anemia
was high in the Nepalese patients with Rheumatic valvular heart disease planned
for elective surgery. There was an increased incidence of blood transfusion,
longer hospital stay, and increased mortality in anemic patients compared to
their non anemic counterparts.