{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:47:19Z","timestamp":1791229639947,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pre\u2010operative anaemia is an established risk factor for mortality after cardiac surgery. The extent to which this risk is mediated by complications related to red blood cell transfusion remains uncertain, particularly across different age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This nationwide cohort study included adult cardiac surgery patients from the Netherlands Heart Registration. Pre\u2010operative anaemia was defined according to World Health Organization criteria and red blood cell transfusion as any red blood cell transfusion during hospital stay. The main study endpoint was 120\u2010day mortality. We used multivariable logistic regression to quantify the associations between pre\u2010operative anaemia, red blood cell transfusion and 120\u2010day mortality. Subsequently, a mediation analysis was conducted to quantify how much of the effect of pre\u2010operative anaemia on postoperative mortality is because of red blood cell transfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 71,053 patients, 14,452 (20.3%) had pre\u2010operative anaemia. Of these, 7621 (52.7%) received red blood cell transfusion during hospital stay, compared with 9930 (17.5%) of patients without anaemia (p\u2009&lt;\u20090.001). Observed 120\u2010day mortality was 612 (4.2%) and 901 (1.6%), respectively. In multivariable regression analysis, pre\u2010operative anaemia remained independently associated with postoperative mortality (adjusted odds ratio 1.66, 95%CI 1.47\u20131.87), with consistent effects across age groups. Mediation analysis showed that red blood cell transfusion accounted for 58.9% (95%CI 41.3\u201376.5%) of the association between pre\u2010operative anaemia and 120\u2010day mortality. The proportion mediated was larger in patients aged \u2265\u200970\u2009years (77.3%, 95%CI 43.1\u2013100%) compared with younger patients (39.3%, 95%CI 21.4\u201357.2%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>A substantial part of the association between pre\u2010operative anaemia and mortality after cardiac surgery is mediated by red blood cell transfusion during hospital stay. The mediating role of red blood cell transfusion was more pronounced in older patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70100","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:32:31Z","timestamp":1765603951000},"page":"646-654","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pre\u2010operative anaemia, red blood cell transfusion and mortality after cardiac surgery: a Netherlands Heart Registration mediation analysis"],"prefix":"10.1111","volume":"81","author":[{"given":"Elisabeth M.","family":"Groenewegen","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain Medicine St Antonius Hospital  Nieuwegein the Netherlands"},{"name":"Department of Intensive Care University Medical Centre Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Noordzij","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain Medicine St Antonius Hospital  Nieuwegein the Netherlands"},{"name":"Department of Intensive Care University Medical Centre Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eline","family":"Vlot","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain Medicine St Antonius Hospital  Nieuwegein the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8680-1380","authenticated-orcid":false,"given":"Saskia","family":"Houterman","sequence":"additional","affiliation":[{"name":"Netherlands Heart Registration  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toni","family":"Klok","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology OLVG  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander J.","family":"Spanjersberg","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Isala Clinic Zwolle  Zwolle the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"Ter Horst","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Erasmus Medical Centre  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost M. A. A.","family":"Van Der Maaten","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology University Medical Centre Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Eberl","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Academic Medical Centre  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remco R.","family":"Berendsen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Leiden University Medical Centre  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Arthur","family":"Bouwman","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Catharina Hospital  Eindhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastiaan M.","family":"Gerritse","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Amphia Hospital  Breda the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry V.","family":"Scohy","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Amphia Hospital  Breda the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes S. E.","family":"Haenen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Medical Centre Leeuwarden  Leeuwarden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Hofland","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Radboud University Medical Centre  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke F.","family":"Kingma","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Haga Hospital  Den Haag the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Van Klarenbosch","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology University Medical Centre Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander","family":"Bramer","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Amphia Hospital  Breda the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel P. J.","family":"De Korte","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Maastricht University Medical Centre  Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicobert E.","family":"Wietsma","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Medical Spectrum Twente  Enschede the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaf L.","family":"Cremer","sequence":"additional","affiliation":[{"name":"Department of Intensive Care University Medical Centre Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lizbeth Burgos","family":"Ochoa","sequence":"additional","affiliation":[{"name":"Department of Methodology, Tilburg School of Social and Behavioral Sciences Tilburg University  the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thijs C. D.","family":"Rettig","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Amphia Hospital  Breda the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the NHR Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.718353"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.12.016"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.04.042"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006779"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2024.02.023"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.698977"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871\u2010019\u20100738\u20102"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2019.03.001"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0141076813479580"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103026(17)30141\u20102"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2015.03.022"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1711818"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102010\u201010\u2010313973"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000513"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.14075"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12471\u2010022\u201001672\u20100"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12471\u2010024\u201001877\u20105"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezs043"},{"key":"e_1_2_6_20_1","unstructured":"World Health Organization.Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011.https:\/\/www.who.int\/publications\/i\/item\/WHO\u2010NMH\u2010NHD\u2010MNM\u201011.1(accessed 07\/11\/2025)."},{"key":"e_1_2_6_21_1","unstructured":"Netherlands Heart Registration.NHR Handboek versie 22.2.1.\u00a02022.https:\/\/nhr.nl\/wp\u2010content\/uploads\/2022\/01\/NHR_HANDBOEK\u201022.2.1_Cardiochirurgie_DEFINITIEF.pdf(accessed 07\/11\/2025)."},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwr525"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010publhealth\u2010032315\u2010021402"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3182a44cb9"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v076.i11"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.7326\/M16\u20102607"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000001064"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjmed\u20102022\u2010000366"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.18224"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2024.01.009"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006765"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2020.04.141"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1403612"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1446"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16542"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000007321"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2023.04.038"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537\u20102995.2010.02675.x"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.11.078"}],"container-title":["Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.70100","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/anae.70100","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.70100","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T03:45:33Z","timestamp":1775792733000},"score":1,"resource":{"primary":{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/10.1111\/anae.70100"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,12]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/anae.70100"],"URL":"https:\/\/doi.org\/10.1111\/anae.70100","archive":["Portico"],"relation":{},"ISSN":["0003-2409","1365-2044"],"issn-type":[{"value":"0003-2409","type":"print"},{"value":"1365-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,12]]},"assertion":[{"value":"2025-10-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}