Effect of Postoperative Permissive Anemia and Cardiovascular Risk Status on Outcomes After Major General and Vascular Surgery Operative Interventions

Panos Kougias, Sherene Sharath, Zhibao Mi, Kousick Biswas, Joseph L Mills

Research output: Contribution to journalArticle

Abstract

Objectives:To determine the effect of postoperative permissive anemia and high cardiovascular risk on postoperative outcomes.Methods:The Veterans Affairs Surgical Quality Improvement Program and Corporate Data Warehouse databases were queried for patients who underwent major vascular or general surgery operations. The status of cardiovascular risk was assessed by calculating the Revised Cardiac Risk Index. Primary endpoint was a composite of mortality, myocardial infarction, acute renal failure, coronary revascularization, or stroke within 90 days postoperatively.Results:We analyzed 142,510 procedures performed from 2000 to 2015. Postoperative anemia was the strongest independent predictor of the primary endpoint whose odds increased by 43% for every g/dL drop in postoperative nadir Hb [95% confidence interval (95% CI): 41-45]. Cardiac risk status as described by the RCRI also independently predicted the primary endpoint, with an additive effect particularly evident at postoperative nadir Hb values below 10gm/dL. Postoperative anemia, after age, was the second strongest independent predictor of long-Term (12 years) mortality (hazard ratio: 1.18, 95% CI: 1.17-1.19).Conclusion:Postoperative anemia is strongly associated with postoperative ischemic events, 90-day mortality, and long-Term mortality. Restrictive transfusion should be used cautiously after major general and vascular operations, particularly in patients at a high cardiovascular risk.

Original languageEnglish (US)
Pages (from-to)602-611
Number of pages10
JournalAnnals of surgery
Volume270
Issue number4
DOIs
StatePublished - Oct 1 2019

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Blood Vessels
Anemia
Mortality
Confidence Intervals
Veterans
Quality Improvement
Acute Kidney Injury
Stroke
Myocardial Infarction
Databases

Keywords

  • cardiac risk
  • general surgery
  • permissive anemia
  • transfusions
  • Vascular surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Effect of Postoperative Permissive Anemia and Cardiovascular Risk Status on Outcomes After Major General and Vascular Surgery Operative Interventions. / Kougias, Panos; Sharath, Sherene; Mi, Zhibao; Biswas, Kousick; Mills, Joseph L.

In: Annals of surgery, Vol. 270, No. 4, 01.10.2019, p. 602-611.

Research output: Contribution to journalArticle

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