Anemia contributes to mortality risk in patients with HF undergoing noncardiac surgery
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Among modifiable risk factors, anemia, as measured by preoperative hematocrit level, contributed the most to mortality risk in patients with HF undergoing noncardiac surgery, according to a research letter published in JAMA Surgery.
Benjamin J. Lerman, MD, MS, who was an MD/MS candidate in the division of epidemiology at Stanford University School of Medicine at the time of the study and is now a resident at Children’s Hospital of Philadelphia, and colleagues performed a gap decomposition analysis to determine the contributions of risk factors to the postoperative mortality gap between patients with HF and those without it.
The cohort included 47,997 patients with HF and 561,738 patients without HF from the Veterans Affairs Surgical Quality Improvement Program database who underwent nonemergency noncardiac surgery between 2009 and 2016.
The 18 variables included in the gap decomposition analysis explained 66.4% of the crude postoperative mortality gap between patients with HF and those without it, the researchers wrote.
The three variables contributing most to the gap were American Society of Anesthesiologists score (20.8%), preoperative hematocrit level (16.5%) and age (12.5%), Lerman and colleagues wrote, noting that, of those, only preoperative hematocrit level (adjusted OR per percentage point = 0.9; 95% CI, 0.89-0.9) is modifiable.
Therefore, the researchers wrote: “Intervention in preoperative anemia might be a target for clinical intervention to improve postoperative mortality in patients with HF. ... Given their abnormal cardiovascular physiology, patients with HF may be more sensitive to perioperative anemia than those without HF, and an optimal hematocrit level in these patients may need to be higher. If future research can identify this optimal level, then low-risk and low-cost interventions, such as preoperative iron infusions or identification and control of sources of bleeding, have the potential to substantially affect postoperative mortality in patients with HF.”
The contributions to the gap for the other modifiable risk factors were 2.79% for chronic obstructive pulmonary disease, 1.89% for CAD, 1.4% for atrial fibrillation, 1.02% for BMI, 0.3% for diabetes, 0.24% for hypertension and 0.01% for alcohol consumption. – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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