 |
|
Preoperative Hematocrit Levels and Postoperative Outcomes in Older Patients Undergoing Noncardiac Surgery
Wen-Chih Wu, MD;
Tracy L. Schifftner, MS;
William G. Henderson, PhD;
Charles B. Eaton, MD;
Roy M. Poses, MD;
Georgette Uttley, RN;
Satish C. Sharma, MD;
Michael Vezeridis, MD;
Shukri F. Khuri, MD;
Peter D. Friedmann, MD
JAMA. 2007;297:2481-2488.
Context Elderly patients are at high risk of both abnormal hematocrit values and cardiovascular complications of noncardiac surgery. Despite nearly universal screening of patients for abnormal preoperative hematocrit levels, limited evidence demonstrates the adverse effects of preoperative anemia or polycythemia.
Objective To evaluate the prevalence of preoperative anemia and polycythemia and their effects on 30-day postoperative outcomes in elderly veterans undergoing major noncardiac surgery.
Design Retrospective cohort study using the VA National Surgical Quality Improvement Program database. Based on preoperative hematocrit levels, we stratified patients into standard categories of anemia (hematocrit <39.0%), normal hematocrit (39.0%-53.9%), and polycythemia (hematocrit  54%). We then estimated increases in 30-day postoperative cardiac event and mortality risks in relation to each hematocrit point deviation from the normal category.
Setting and Patients A total of 310 311 veterans aged 65 years or older who underwent major noncardiac surgery between 1997 and 2004 in 132 Veterans' Affairs medical centers across the United States.
Main Outcome Measures The primary outcome measure was 30-day postoperative mortality; a secondary outcome measure was composite 30-day postoperative mortality or cardiac events (cardiac arrest or Q-wave myocardial infarction).
Results Thirty-day mortality and cardiac event rates increased monotonically, with either positive or negative deviations from normal hematocrit levels. We found a 1.6% (95% confidence interval, 1.1%-2.2%) increase in 30-day postoperative mortality associated with every percentage-point increase or decrease in the hematocrit value from the normal range. Additional analyses suggest that the adjusted risk of 30-day postoperative mortality and cardiac morbidity begins to rise when hematocrit levels decrease to less than 39% or exceed 51%.
Conclusions Even mild degrees of preoperative anemia or polycythemia were associated with an increased risk of 30-day postoperative mortality and cardiac events in older, mostly male veterans undergoing major noncardiac surgery. Future studies should determine whether these findings are reproducible in other populations and if preoperative management of anemia or polycythemia decreases the risk of postoperative mortality.
Author Affiliations: Target Research Enhancement Program, Providence Veterans Affairs Medical Center and Department of Community Health (Drs Wu and Friedmann), Department of Medicine (Drs Wu, Poses, Sharma, and Friedmann), Center for Primary Care and Prevention, Memorial Hospital of Rhode Island and Department of Family Medicine (Dr Eaton), and Surgical Service, Providence Veterans Affairs Medical Center and Department of Surgery (Ms Uttley and Dr Vezeridis), Brown Medical School, and Medical Service, Providence Veterans Affairs Medical Center (Drs Wu and Sharma), Providence, RI; National Surgical Quality Improvement Program Denver Data Analysis Center, Denver VA Medical Center, University of Colorado Health Outcomes Program, Denver (Ms Schifftner and Dr Henderson); and Surgical Service VA Boston Healthcare System and Department of Surgery, Harvard Medical School, Boston, Mass (Dr Khuri).
RELATED LETTERS
Preoperative Hematocrit Levels and Outcomes After Noncardiac Surgery
Filippo Bellati, Francesco Plotti, and Pierluigi Benedetti Panici
JAMA. 2007;298(13):1512.
EXTRACT
| FULL TEXT
Preoperative Hematocrit Levels and Outcomes After Noncardiac Surgery
Edward C. Nemergut, Keith E. Littlewood, and Duncan G. de Souza
JAMA. 2007;298(13):1512-1513.
EXTRACT
| FULL TEXT
Preoperative Hematocrit Levels and Outcomes After Noncardiac Surgery—Reply
Wen-Chih Wu, Tracy L. Schifftner, and William G. Henderson
JAMA. 2007;298(13):1513-1514.
EXTRACT
| FULL TEXT
RELATED ARTICLES
Preoperative Anemia in Noncardiac Surgery: High Prevalence and Worse Outcome?
Lena M. Napolitano
Arch Surg. 2007;142(11):1031-1032.
EXTRACT
| FULL TEXT
Hematocrit Level and Postsurgical Outcome: Powers of Observation
Farhood Farjah and David R. Flum
JAMA. 2007;297(22):2525-2526.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Perioperative anaemia management: consensus statement on the role of intravenous iron
Beris et al.
Br J Anaesth 2008;100:599-604.
ABSTRACT
| FULL TEXT
Postoperative Anemia and Quality of Life After Primary Hip Arthroplasty in Patients Over 65 Years Old
Conlon et al.
Anesth. Analg. 2008;106:1056-1061.
ABSTRACT
| FULL TEXT
Somatic inactivation of the PHD2 prolyl hydroxylase causes polycythemia and congestive heart failure
Minamishima et al.
Blood 2008;111:3236-3244.
ABSTRACT
| FULL TEXT
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
Fleisher et al.
Circulation 2007;116:e418-e499.
FULL TEXT
Preoperative Hematocrit Levels and Outcomes After Noncardiac Surgery
Bellati et al.
JAMA 2007;298:1512-1512.
FULL TEXT
Preoperative Hematocrit Levels and Outcomes After Noncardiac Surgery
Nemergut et al.
JAMA 2007;298:1512-1513.
FULL TEXT
Hematocrit Level and Postsurgical Outcome: Powers of Observation
Farjah and Flum
JAMA 2007;297:2525-2526.
FULL TEXT
|
