Home Blood / Hematology Permissive Anemia Adversely Affects Postoperative Outcomes in Men

Permissive Anemia Adversely Affects Postoperative Outcomes in Men

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According to the results of a study published in the Annals of Surgery, postoperative permissive anemia appears to adversely affect outcomes, including ischemic events, 90-day mortality, and long-term mortality.

Researchers
conducted a retrospective study of patients who underwent major vascular or
general surgery procedures within the Veterans Health Administration system
between January 2000 and December 2015. The team obtained data from the
Veterans Affairs Surgical Quality Improvement Program and Corporate Data
Warehouse databases and examined the effects of postoperative permissive anemia
and high cardiovascular risk, which was measured using the Cardiac Risk Index. The
primary end point was a composite of mortality, myocardial infarction, acute
renal failure, coronary revascularization, or postoperative stroke within 90
days.

A
total of 142,510 procedures were analyzed. The study population was predominantly
male (96.7%) with an average patient age of 65 years (range, 18-90).

The
strongest independent predictor of the composite primary end point was
postoperative anemia (odds ratio, 1.43; 95% CI, 1.41-1.45). Cardiac risk status
was also an independent predictor of the primary end point, and the interaction
between cardiac risk status and postoperative anemia was significant (odds
ratio, 1.04; P <.001), suggesting
that patients with high cardiac risk are more sensitive to postoperative anemia
compared with patients with lower cardiac risk.

In
a multivariate analysis of the secondary end point, long-term mortality, age
(hazard ratio, 1.042; 95% CI: 1.041-1.043; P
<.001) and postoperative anemia (HR, 1.18; 95% CI, 1.17-1.19; P <.001) were the strongest
predictors.

“Until
a randomized controlled trial settles this issue definitively, a restrictive
transfusion strategy should be used with caution in male patients at high
cardiac risk who undergo major general and vascular surgery operations,” wrote
the authors.

Reference

  1. Kougias P, Sharath S, Mi Z, Biswas K, Mills JL. Effect of postoperative permissive anemia and cardiovascular risk status on outcomes after major general and vascular surgery operative interventions [published online October 1, 2019]. Ann Surg. doi:10.1097/SLA.0000000000003525

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