{
  "abstract": "Background/Objectives: Sex-specific anemia criteria classify women with hemoglobin (Hb) 12.0–12.9 g/dL as non-anemic. We assessed whether World Health Organization (WHO) criteria underrecognize red blood cell (RBC) transfusion risk compared with a uniform patient blood management (PBM) threshold of Hb <13.0 g/dL in elective open cardiac valve surgery (CVS). Methods: This nationwide retrospective cohort included adults undergoing elective open CVS in 40 Spanish centers (2016–2024), 32 of which reported preoperative Hb. Hb was modeled continuously and in three strata (<12.0, 12.0–12.9, ≥13.0 g/dL). The primary outcome was RBC transfusion; secondary outcomes were postoperative complications, length of stay, and in-hospital mortality within 30 days. Mixed-effects models adjusted for age, comorbidity burden, surgical complexity, valve position, year of surgery, and center. Results: Among 29,757 eligible patients, 20,017 had available Hb measurements; 9247 (46.2%) were women, including 2333 (25.2%) with Hb 12.0–12.9 g/dL. In this stratum, 68.0% of women and 52.7% of men received RBC transfusions. The adjusted between-sex probability difference was 15.1 percentage points (95% CI, 11.4–18.9; adjusted odds ratio, 1.85; 95% CI, 1.59–2.16). The categorical sex × Hb interaction was significant (p < 0.001), whereas the continuous interaction was not (p = 0.486). Sex did not significantly modify the Hb associations with complications or in-hospital mortality within 30 days. Conclusions: Women with Hb 12.0–12.9 g/dL had substantial transfusion risk despite being classified as non-anemic by the WHO criteria. Hb <13.0 g/dL may be a pragmatic sex-inclusive trigger for perioperative risk recognition and etiologic evaluation, not a proven therapeutic target.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anesthesiology, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain",
    "Neuroscience Research Group—Perioperative Pathophysiology and Pain Unit, Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Spain",
    "Perioperative Medicine Research Group, Hospital del Mar Research Institute, 08003 Barcelona, Spain",
    "Department of Anesthesia, Hospital del Mar, 08003 Barcelona, Spain",
    "Department of Anesthesiology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain",
    "Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, 08907 L’Hospitalet de Llobregat, Spain"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Esther Méndez",
      "orcid": "0000-0003-2335-5210"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Elvira Bisbe",
      "orcid": "0000-0001-6723-7350"
    },
    {
      "affs": [
        4
      ],
      "name": "Misericordia Basora",
      "orcid": "0000-0002-1892-5330"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Adrián Vizoso",
      "orcid": "0009-0000-9020-7512"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Albert García-Casanovas",
      "orcid": "0000-0001-9922-2516"
    },
    {
      "affs": [
        0,
        1,
        5
      ],
      "name": "Maria J. Colomina",
      "orcid": "0000-0003-0106-0956"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8zhyweybdssf3.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15218632",
  "fulltext_url": null,
  "id": "8zhyweybdssf3",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/21/8632",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-05",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/8zhyweybdssf3.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T00:21:25Z",
      "native_id": "10.3390/jcm15218632",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/21/8632"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "When “Normal” Hemoglobin May Not Be Enough: Sex-Specific Anemia Thresholds and Outcomes in Cardiac Surgery",
  "title_text": "When “Normal” Hemoglobin May Not Be Enough: Sex-Specific Anemia Thresholds and Outcomes in Cardiac Surgery",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T00:21:23Z",
  "url": "https://research.draconitic.com/paper/8zhyweybdssf3",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}