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

Prateek K. Gupta, Abhishek Sundaram, Jason N Mactaggart, Jason M Johanning, Himani Gupta, Xiang Fang, Robert Armour Forse, Marcus Balters, G Matthew Longo, Jeffrey T. Sugimoto, Thomas G. Lynch, Iraklis I Pipinos

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1096-1102
Number of pages7
JournalAnnals of surgery
Volume258
Issue number6
DOIs
StatePublished - Dec 1 2013

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Blood Vessels
Anemia
Hematocrit
Mortality
Reference Values
Preoperative Care
Endovascular Procedures
Heart Arrest
Multivariate Analysis
Myocardial Infarction
Databases
Confidence Intervals
Population
Therapeutics

Keywords

  • anemia
  • endovascular
  • hemoglobin
  • outcomes
  • vascular

ASJC Scopus subject areas

  • Surgery

Cite this

Preoperative anemia is an independent predictor of postoperative mortality and adverse cardiac events in elderly patients undergoing elective vascular operations. / Gupta, Prateek K.; Sundaram, Abhishek; Mactaggart, Jason N; Johanning, Jason M; Gupta, Himani; Fang, Xiang; Forse, Robert Armour; Balters, Marcus; Longo, G Matthew; Sugimoto, Jeffrey T.; Lynch, Thomas G.; Pipinos, Iraklis I.

In: Annals of surgery, Vol. 258, No. 6, 01.12.2013, p. 1096-1102.

Research output: Contribution to journalArticle

Gupta, Prateek K. ; Sundaram, Abhishek ; Mactaggart, Jason N ; Johanning, Jason M ; Gupta, Himani ; Fang, Xiang ; Forse, Robert Armour ; Balters, Marcus ; Longo, G Matthew ; Sugimoto, Jeffrey T. ; Lynch, Thomas G. ; Pipinos, Iraklis I. / Preoperative anemia is an independent predictor of postoperative mortality and adverse cardiac events in elderly patients undergoing elective vascular operations. In: Annals of surgery. 2013 ; Vol. 258, No. 6. pp. 1096-1102.
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abstract = "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.",
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T1 - Preoperative anemia is an independent predictor of postoperative mortality and adverse cardiac events in elderly patients undergoing elective vascular operations

AU - Gupta, Prateek K.

AU - Sundaram, Abhishek

AU - Mactaggart, Jason N

AU - Johanning, Jason M

AU - Gupta, Himani

AU - Fang, Xiang

AU - Forse, Robert Armour

AU - Balters, Marcus

AU - Longo, G Matthew

AU - Sugimoto, Jeffrey T.

AU - Lynch, Thomas G.

AU - Pipinos, Iraklis I

PY - 2013/12/1

Y1 - 2013/12/1

N2 - 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.

AB - 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.

KW - anemia

KW - endovascular

KW - hemoglobin

KW - outcomes

KW - vascular

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