Preoperative anemia is an independent predictor of postoperative mortality and adverse cardiac events in elderly patients undergoing elective vascular operations.

Gupta PK, Sundaram A, MacTaggart JN, et al.
Ann Surg 2013;248:1096-1102.
NATA Rating :
Review by : J. A. Garcia-Erce, C. Vagianos
NATA Review

Peripheral arterial disease is common in the elderly population and is estimated to occur in up to 29% of patients older than 70 years and in an increasing number of elderly patients undergoing vascular procedures.

This study retrospectively analyzed a three-year, prospectively collected, multicenter database (more than 200 centers) of all elective vascular procedures. The authors provided high quality data collection, with only 1.6% disagreements from the American College of Surgeons’ National Surgical Quality Improvement Program. Only emergent vascular procedures and patients transfused with more than 4 units were excluded.

Of a total of 31,857 patients in whom elective vascular procedures were performed, 47.9% had preoperative anemia. Anemic patients were more likely to be females and had more cardiac comorbidities, dependent functional state, requirement for dialysis and abnormal creatinine levels. Postoperative (30-day) mortality and cardiac event rate were 2.4% and 2.3%, respectively, in patients with preoperative anemia compared with 1.2% and 1.2%, respectively, in patients with a preoperative hematocrit within the normal range (P < 0.0001). On multivariate analyses, age, dyspnea, dependent functional state, intraoperative packed red blood cell transfusions, number of units transfused, duration of anesthesia, type of vascular procedure and preoperative hematocrit were significantly associated with 30-day mortality. The interaction of these variables was assessed but none was identified, suggesting, once again, an independent effect of preoperative anemia on 30-day mortality and morbidity, also independent of albumin levels. This is one more evidence against preoperative anemia and another reason to treat perioperative anemia (or at least to study it). – José A. García-Erce

The objective of this study was to examine the impact of preoperative anemia (hematocrit < 39%) on postoperative 30-day mortality and adverse cardiac events in patients 65 years or older, undergoing elective vascular procedures. This was approached by retrospectively analyzing 31,857 patients retrieved from the American College of Surgeons’ 2007–2009 National Surgical Quality Improvement Program. The patients were analyzed in subgroups, according to the degree of anaemia (11 subgroups, anemia from 39 to 24% Hct), as well as type of operation and comorbidity. Despite some methodological limitations, also identified by the authors, the study clearly shows that both the presence and degree of anemia are associated with an increased risk of death and adverse cardiac events in elderly patients undergoing elective vascular operations. Although further randomized clinical trials are required, this study brings up the potential advantages of routine preoperative anemia correction by recombinant human erythropoietin (rHuEpo) and iron supplementation in this group of high-risk patients. – Constantine Vagianos