Abstract 10631: Red-Cell Distribution Width (RDW) is an Independent Predictor of Adverse Cardiovascular Outcomes in Elderly Patients Following Non-Cardiac Surgery
Background: Red blood cell distribution width (RDW) is a prognostic marker for mortality in patients with congestive heart failure (CHF) and acute coronary syndrome (ACS). RDW is considered a surrogate marker of bone marrow stress. Old age, CHF, ACS, and surgery have been associated with high sympathetic tone and abnormal cytokine profile, which can alter bone marrow sensitivity to erythropoietin to result in release of premature red cells leading to high RDW. We investigated whether preoperative RDW can predict adverse cardiac events and all-cause mortality within 30 days following elective non-cardiac surgery in elderly patients (≥65 years).
Methods: We performed a retrospective cohort study of persons aged ≥65 years (N=898) enrolled in the Michigan Surgical Quality Collaborative (MSQC) that underwent elective non-cardiac surgery from 2004-2011. We excluded patients with baseline anemia, major intra/postoperative complications and emergency surgery. We examined the National Surgical Quality Improvement Program(NSQIP) parameters to compare 30-day outcomes for study participants, who were then divided into 4 RDW quartiles (Q1: ≤12.50, Q2: 12.51-13.40, Q3: 13.41-14.05, Q4: ≥ 14.06).
Results: The mean age of study population was 72.4±6.8 years. Study groups were adjusted for confounding variables if present, including demographics, surgical issues and comorbidities. In comparison to lowest quartile(Q1), patients in highest quartile(Q4) demonstrated increased all-cause mortality(adjusted odds ratio=3.56, 95% CI=1.4-9.1), increased ACS (4.18, 1.6-10.4), increased arrhythmias (1.87, 1.2-2.8), increased hospitalization for CHF exacerbation (4.11, 1.1-14.6) and increased sudden cardiac death (4.17, 1.3-12.6).
Conclusions: Preoperative RDW is directly associated with all-cause mortality and adverse cardiovascular events within 30 days following elective non-cardiac surgery in patients ≥65 years old. RDW may serve as a non-invasive marker to risk stratify elderly patients prior to elective non-cardiac surgery and identify those who might benefit from close monitoring for potentially remediable cardiovascular changes during early post-operative period.
- © 2013 by American Heart Association, Inc.