Effect of Postoperative Permissive Anemia and Cardiovascular Risk Status on Outcomes After Major General and Vascular Surgery Operative Interventions.
Ann Surg
; 270(4): 602-611, 2019 10.
Article
en En
| MEDLINE
| ID: mdl-31478978
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 10âgm/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.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
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Cirugía General
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Procedimientos Quirúrgicos Vasculares
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Enfermedades Cardiovasculares
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Anemia
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Ann Surg
Año:
2019
Tipo del documento:
Article