Association between preoperative anemia optimization and major complications after non-cardiac surgery: a retrospective analysis
Associação entre otimização da anemia pré-operatória e complicações maiores após cirurgia não cardíaca: uma análise retrospectiva
Federico Almonacid-Cardenas, Eva Rivas, Moises Auron, Lucille Hu, Dong Wang, Liu Liu, Deborah Tolich, Edward J. Mascha, Kurt Ruetzler, Andrea Kurz, Alparslan Turan
Abstract
Background
Anemia is common in the preoperative setting and associated with increased postoperative complications and mortality. However, it is unclear if preoperative anemia optimization reduces postoperative complications. We aimed to assess the association between preoperative anemia optimization and a composite endpoint of major cardiovascular, renal, and pulmonary complications and all-cause mortality within 30 days after noncardiac surgery in adult patients.
Methods
In this retrospective analysis preoperative anemia was defined as hemoglobin concentration below 12.0 g.dl−1 in women and 13.0 g.dl−1 in men within 6 months before surgery. A propensity score-based generalized estimating equation analysis was used to determine the association between preoperative anemia optimization and the primary outcome. Moreover, mediation analysis was conducted to investigate whether intraoperative red blood cell transfusion or duration of intraoperative hypotension were mediators of the relation between anemia optimization and the primary outcome.
Results
Fifty-seven hundred anemia optimized, and 8721 non-optimized patients met study criteria. The proportion of patients having any component of the composite of major complications and all-cause mortality was 21.5% in the anemia-optimized versus 18.0% in the non-optimized, with confounder-adjusted odds ratio estimate of 0.99 (95% CI 0.86‒1.15) for anemia optimization versus non-optimization, p = 0.90. Intraoperative red blood cell transfusion had a minor mediation effect on the relationship between preoperative anemia optimization and the primary outcome, whereas duration of intraoperative hypotension was not found to be a mediator.
Conclusion
Preoperative anemia optimization did not appear to be associated with a composite outcome of major in-hospital postoperative cardiovascular, renal, and pulmonary complications and all-cause in-hospital mortality.
Keywords
Resumo
Introdução
A anemia é comum no pré-operatório e está associada ao aumento de complicações pós-operatórias e mortalidade. No entanto, não está claro se a otimização da anemia pré-operatória reduz as complicações pós-operatórias. Nosso objetivo foi avaliar a associação entre a otimização da anemia pré-operatória e um desfecho composto de complicações cardiovasculares, renais e pulmonares importantes e mortalidade por todas as causas dentro de 30 dias após cirurgia não cardíaca em pacientes adultos.
Métodos
Nesta análise retrospectiva, a anemia pré-operatória foi definida como concentração de hemoglobina abaixo de 12,0 g.dl-1 em mulheres e 13,0 g.dl-1 em homens nos 6 meses anteriores à cirurgia. Uma análise de equação de estimativa generalizada baseada em escore de propensão foi usada para determinar a associação entre a otimização da anemia pré-operatória e o desfecho primário. Além disso, foi realizada análise de mediação para investigar se a transfusão intraoperatória de hemácias ou a duração da hipotensão intraoperatória eram mediadores da relação entre a otimização da anemia e o desfecho primário.
Resultados
Cinquenta e setecentos pacientes com anemia otimizada e 8.721 pacientes não otimizados preencheram os critérios do estudo. A proporção de pacientes com qualquer componente do composto de complicações maiores e mortalidade por todas as causas foi de 21,5% nos pacientes otimizados para anemia versus 18,0% nos não otimizados, com estimativa de razão de probabilidade ajustada para fatores de confusão de 0,99 (IC 95% 0,86‒ 1,15) para otimização da anemia versus não otimização, p = 0,90. A transfusão intraoperatória de glóbulos vermelhos teve um efeito mediador menor na relação entre a otimização da anemia pré-operatória e o desfecho primário, enquanto a duração da hipotensão intraoperatória não foi considerada um mediador.
Conclusão
A otimização da anemia pré-operatória não pareceu estar associada a um resultado composto de grandes complicações cardiovasculares, renais e pulmonares no pós-operatório hospitalar e mortalidade hospitalar por todas as causas.
Palavras-chave
References
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Submitted date:
06/16/2023
Accepted date:
11/22/2023
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