Postoperative anemia independently predicted a 90-day composite of mortality and ischemic events, with odds increasing by 43% for every 1 g/dL drop in nadir Hb (OR 1.43; 95% CI 1.41-1.45).
Cohort (n=142,510)
Yes
Does postoperative permissive anemia and high cardiovascular risk affect 90-day and long-term outcomes in patients undergoing major general and vascular surgery?
Postoperative anemia is a strong independent predictor of 90-day ischemic events and long-term mortality after major general and vascular surgery, suggesting restrictive transfusion strategies should be used cautiously in high-risk patients.
Effect estimate: OR 1.43 (95% CI 1.41-1.45)
OBJECTIVES: To determine the effect of postoperative permissive anemia and high cardiovascular risk on postoperative outcomes. METHODS: The Veterans Affairs Surgical Quality Improvement Program and Corporate Data Warehouse databases were queried for patients who underwent major vascular or general surgery operations. The status of cardiovascular risk was assessed by calculating the Revised Cardiac Risk Index. Primary endpoint was a composite of mortality, myocardial infarction, acute renal failure, coronary revascularization, or stroke within 90 days postoperatively. RESULTS: We analyzed 142,510 procedures performed from 2000 to 2015. Postoperative anemia was the strongest independent predictor of the primary endpoint whose odds increased by 43% for every g/dL drop in postoperative nadir Hb 95% confidence interval (95% CI): 41-45. Cardiac risk status as described by the RCRI also independently predicted the primary endpoint, with an additive effect particularly evident at postoperative nadir Hb values below 10 gm/dL. Postoperative anemia, after age, was the second strongest independent predictor of long-term (12 years) mortality (hazard ratio: 1.18, 95% CI: 1.17-1.19). CONCLUSION: Postoperative anemia is strongly associated with postoperative ischemic events, 90-day mortality, and long-term mortality. Restrictive transfusion should be used cautiously after major general and vascular operations, particularly in patients at a high cardiovascular risk.
Kougias et al. (Fri,) conducted a cohort in Major vascular or general surgery (n=142,510). Postoperative permissive anemia was evaluated on Composite of mortality, myocardial infarction, acute renal failure, coronary revascularization, or stroke within 90 days postoperatively (OR 1.43, 95% CI 1.41-1.45). Postoperative anemia independently predicted a 90-day composite of mortality and ischemic events, with odds increasing by 43% for every 1 g/dL drop in nadir Hb (OR 1.43; 95% CI 1.41-1.45).