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Preoperative anemia increases mortality risk after surgery for CLI
Patients with critical limb ischemia are at greater immediate- and long-term risk for death after surgery if they have anemia before undergoing treatment, according to recent results.
This increased risk is present regardless of the type of revascularization performed and independent of other risk factors, the researchers wrote.
The study included 403 patients (mean age, 73 years; 73% men) who underwent endovascular (n = 212) or open surgery (n = 191) to treat critical limb ischemia (CLI) at a single facility in Barcelona, Spain, between 2005 and 2013. Hemoglobin levels were obtained before the procedure to determine the presence of preoperative anemia, defined as less than 13 g/dL among men and less than 12 g/dL among women. The primary endpoint was immediate- and long-term survival, with follow-up during a mean of 30 months.
Patients had preoperative anemia in 75% of cases. The immediate mortality rate, defined as death in-hospital or within 30 days of treatment, was 8%, and did not differ significantly between the endovascular and open surgery groups (8.5% and 7.3%, respectively). The researchers identified a level of less than 10 g/dL as the optimal cutoff point relating preoperative hemoglobin to immediate survival, with a discriminative capacity of 0.665 (95% CI, 0.6-0.8) on receiver operating characteristic curve analysis. Preoperative hemoglobin of less than 10 g/dL was present in 22% of patients, and immediate mortality risk was significantly greater in this subpopulation (17.7% vs. 5.1% among those with levels more than 10 g/dL; adjusted OR = 3.9; 95% CI, 1.8-8.4).
Among 391 patients with evaluable follow-up data, survival rates were 77% at 1 year and 45% at 5 years, with no significant differences observed according to surgery type. Survival rate was significantly lower among patients with preoperative hemoglobin of less than 10 g/dL at both 1 year (55% vs. 83% among those with levels more than 10 g/dL) and 5 years after treatment (21% vs. 53%; adjusted HR = 2.5; 95% CI, 1.8-3.4).
Analysis of patients in the endovascular group alone indicated no differences in immediate survival among patients with and without preoperative anemia (P = .363), but long-term survival was poorer with low hemoglobin levels (P < .001). In the open surgery group, higher immediate- and long-term mortality rates were observed among patients with preoperative anemia (P < .001 for both).
“Preoperative anemia was identified as a risk factor for immediate and late mortality among patients with CLI, regardless of other risk factors and the type of revascularization technique,” the researchers wrote.
Treatment of anemia before surgery is recommended, but “the best management for preoperative anemia in CLI patients still remains unclear,” they wrote. – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.