Background: Anemia and transfusion are associated with poor cancer outcomes. Geriatric cancer patients often have increased baseline anemia, however the relationship between anemia, transfusion, and outcomes in this group is unknown. We sought to evaluate the impact of anemia and transfusion on perioperative outcomes for surgical geriatric cancer patients. Study Design: Adult surgical cancer patients were identified in the ACS-NSQIP database. Patients were stratified by age, degree of anemia, and primary disease site. Factors associated with 30-day complications were evaluated by logistic regression. Results: 411,710 cancer patients underwent surgery (>65yo: 226,240; >75yo: 105,280). Cancers were lower GI (46.3%), genitourinary (GU) (25.7%), hepatobiliary (16.4%), upper GI (7.2%), and gynecologic (GYN) (4.4%). 16,383 had postoperative anemia requiring transfusion (PART). Male sex (OR 0.71, CI 0.69-0.73), older age (OR 0.64, CI 0.60-0.69), and GU/GYN cancers had fewer severe complications, while inpatient rehab (OR 3.66, CI 3.51-3.82), higher BMI (OR 1.15, CI 1.10-1.24), and PART (OR 1.96, CI 1.86-2.06) had more severe complications. PART in patients >75yo was most associated with severe complications (OR 1.66, p<0.001). Conclusions: Geriatric surgical patients with PART have increased risk of severe postoperative complications, regardless of anemia severity. Preoperative optimization is imperative in this population. Further prospective data is needed to delineate highest PART risk.
Hendrick et al. (2026) studied this question.