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Preoperative Anemia Is an Independent Predictor of Postoperative Mortality and Adverse Cardiac Events in Elderly Patients Undergoing Elective Vascular Operations

Gupta, Prateek K. MD*; Sundaram, Abhishek MBBS, MPH; MacTaggart, Jason N. MD; Johanning, Jason M. MD; Gupta, Himani MD§; Fang, Xiang PhD; Forse, Robert Armour MD, PhD; Balters, Marcus MD; Longo, Gernon Matthew MD; Sugimoto, Jeffrey T. MD; Lynch, Thomas G. MD; Pipinos, Iraklis I. MD, PhD

doi: 10.1097/SLA.0b013e318288e957
Original Articles

Objective: The objective of this study was to assess 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.

Background: Preoperative anemia is associated with adverse outcomes after cardiac surgery, but its association with postoperative outcomes after open and endovascular procedures is not well established. Elderly patients have a decreased tolerance to anemia and are at high risk for complications after vascular procedures.

Methods: Patients (N = 31,857) were identified from the American College of Surgeons' 2007–2009 National Surgical Quality Improvement Program—a prospective, multicenter (>250) database maintained across the United States. The primary and secondary outcomes of interest were 30-day mortality and a composite end point of death or cardiac event (cardiac arrest or myocardial infarction), respectively.

Results: Forty-seven percent of the study population was anemic. Anemic patients had a postoperative mortality and cardiac event rate of 2.4% and 2.3% in contrast to the 1.2% and 1.2%, respectively, in patients with hematocrit within the normal range (P < 0.0001). On multivariate analysis, we found a 4.2% (95% confidence interval, 1.9–6.5) increase in the adjusted risk of 30-day postoperative mortality for every percentage point of hematocrit decrease from the normal range.

Conclusions: The presence and degree of preoperative anemia are independently associated with 30-day death and adverse cardiac events in patients 65 years or older undergoing elective open and endovascular procedures. Identification and treatment of anemia should be important components of preoperative care for patients undergoing vascular operations.

Forty-seven percent of patients 65 years or older undergoing elective open and endovascular procedures (N = 31,857) were anemic. Preoperative anemia was independently associated with 30-day death, with a 4.2% increase in the adjusted risk of 30-day postoperative mortality for every percentage point of hematocrit decrease from the normal range.

*Department of Surgery, University of Wisconsin Hospital & Clinics, Madison, WI

Department of Surgery, Creighton University, Omaha, NE

Departments of Surgery, University of Nebraska Medical Center, and VA Nebraska and Western Iowa Health Care System, Omaha, NE

§Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI

Biostatistical Core, Creighton University, Omaha, NE.

Reprints: Iraklis I. Pipinos, MD, PhD, Departments of Surgery, University of Nebraska Medical Center, and VA Nebraska and Western Iowa Health Care System, Omaha, NE 68154. E-mail: ipipinos@unmc.edu.

Supported in part by the NIH grant R01 AG034995, the William J. von Liebig Award by the American Vascular Association, and the Charles and Mary Heider Fund for Excellence in Vascular Surgery.

The American College of Surgeons' (ACS) National Surgical Quality Improvement Program (NSQIP) and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. This study does not represent the views or plans of the ACS or the ACS NSQIP.

Disclosure: The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.