Association of postoperative haemoglobin with adverse outcomes in patients undergoing cardiac surgery: a retrospective single centre cohort study

Alkadri, J; Chen, M; Karkouti, K; Morais, S; Saskin, R; Grudzinski, A; Ouzounian, M; Callum, J; Lin, Y; McCluskey, SA; McIsaac, DI; Bartoszko, J

doi:10.1016/j.bjao.2025.100508

Cardiothoracic & vascular anesthesia

Association of postoperative haemoglobin with adverse outcomes in patients undergoing cardiac surgery: a retrospective single centre cohort study

BJA OpenPublished 17 Dec 2025Retrospective cohort study

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Authors' conclusion

In postoperative cardiac surgical patients, progressive decreases in postoperative haemoglobin are associated with increased risk of mortality and major morbidity at 30 days.

Study context

Population: Adults (≥18 yr) undergoing coronary revascularisation, valve surgery, or a combination at Toronto General Hospital, 2016–2020
Participants: 5,960 adults

Exposure: POD1 haemoglobin ≤80 g L-1 vs >80 g L-1, and per 10 g L-1 decrease
Haemoglobin ≤80 g L-1n = 1,794
Outcome: Composite of:
Mortality
Stroke
MI
AKI
Sternal wound infection
A combination
Follow-up: 30 days

Methodological detailssingle-centre

Single-centre

Main finding

As reported in the abstract

Primary composite outcome

Adjusted odds ratio (CI)P value

Each 10 g L-1 decrease in POD1 haemoglobin

1.15(1.05–1.25)

P < 0.001

Haemoglobin ≤80 g L-1 vs Haemoglobin >80 g L-1

1.44(1.19–1.75)

P < 0.001

Observational data: associations, not effects.

Secondary outcomes

Outcome	← Lower risk ←→ Higher risk →	Adjusted IRR (CI)	P value
Incidence of adverse eventsEach 10 g L-1 decrease in haemoglobin · Poisson regression; adjusted for clustering and confounders	0.512	1.14 (1.07–1.20)	P < 0.001
	0.512Adjusted incidence rate ratio (log scale)

Incidence of adverse events

	← Lower risk ←→ Higher risk →	Adjusted IRR (CI)	P value
Haemoglobin <80 g L-1Poisson regression; adjusted for clustering and confounders	0.512	1.33 (1.16–1.54)	P < 0.001
	0.512Adjusted incidence rate ratio (log scale)

RBC transfusion

Transfused, whole cohort: 49%
Transfused, POD1 haemoglobin ≤80 g L-1: 90%

Original publication

Association of postoperative haemoglobin with adverse outcomes in patients undergoing cardiac surgery: a retrospective single centre cohort study. BJA Open. Published 17 December 2025. doi:10.1016/j.bjao.2025.100508

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