Abstract 8947: Preoperative Anemia is an Independent Predictor of Postoperative Mortality and Adverse Cardiac Events in Elderly Patients Undergoing Elective Vascular Operations

Abstract

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. 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 of age undergoing elective vascular procedures.

Methods and Results: Patients (n=31,857) were identified from the American College of Surgeons' 2007-09 National Surgical Quality Improvement Program (NSQIP) - 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. 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 undergoing elective open and endovascular procedures. Identification and treatment of anemia should be an important component of preoperative care for patients undergoing vascular operations.