Preoperative Hematocrit Levels and Postoperative Outcomes in Older Patients Undergoing Noncardiac Surgery

Abstract

creased risk of both abnormal hematocrit values and cardiovascular complications of noncardiac surgery. 1,2 Despite nearly universal measurement of hematocrit values prior to major surgery, 3 the prognostic implications of preoperative anemia or polycythemia are incompletely understood for this high-risk population. Although we have previously found that even mild degrees of anemia increase the mortality risk of elderly patients with acute myocardial infarction, 4 surgical studies of mild anemia have not shown it to be a risk factor for death, unless cardiac disease is present or major blood loss occurs. [5][6][7] The limited physiologic reserve and the higher prevalence of unrecognized cardiovascular disease may still render the elderly population vulnerable to milder degrees of anemia when undergoing the stress of surgery. [8][9][10] For editorial comment see p 2525.

Reassessing the risk of hemodilutional anemia: Some new pieces to an old puzzle

“…Despite these adaptations, increasing clinical evidence supports a strong association between anemia, increased organ injury, and mortality. [1][2][3][4][5][6][7][8][9][10] With the advent of modern medical intervention, the initial treatment of acute blood loss is fluid resuscitation with crystalloid and/or colloid. This treatment has led to an increased incidence of normovolemic hemodilution (hemodilution) in many clinical settings, including the operating room and intensive care unit.…”

S-nitrosylation therapy to improve oxygen delivery of banked blood

“…However, it is unclear how often transfusion meets this goal. Although blood transfusion can be life-saving, evidence continues to accumulate that administration of stored RBCs may not always be beneficial and, in some settings, may actually cause harm (1-6), findings of particular concern because even mild anemia is prognostic of adverse outcomes (7,8).…”

Anemia and Transfusions in Surgical Patients: Current Concepts and Future Directions

“…In patients who refuse blood products, a direct correlation was found between decreasing preoperative hemoglobin levels and increasing incidence of postoperative complications and rising mortality [12,13]. Large retrospective analyses have confirmed anemia as an independent risk factor for postoperative complications in general (non-cardiac) surgery [11,12,14,15,17], as well as in high-risk cardiac and vascular surgery [5,16,19].…”

“…the preoperative setting indeed has significant clinical implications, and is more than just a marker of co-morbidities [5,[11][12][13][14][15][16][17][18]. In patients who refuse blood products, a direct correlation was found between decreasing preoperative hemoglobin levels and increasing incidence of postoperative complications and rising mortality [12,13].…”