Photo Credit: Artoleshko

Preoperatively assessing anemia as a modifiable risk factor may counteract increased mortality risk for patients with severe anemia and frailty.

“The World Health Organization and many academic medical societies have urged the adoption of patient blood management (PBM) disciplines, yet anemia is not routinely optimized as a preoperative risk factor,” the researchers wrote in Anesthesia & Analgesia. “Given the well-defined association between preoperative anemia and postoperative morbidity and mortality, performing elective surgery on an untreated anemic patient should be considered substandard care.”

For this retrospective study, Keith Howell, MD, and colleagues looked at anemia’s relationship to two primary surgical outcomes and three secondary outcomes. Primary outcomes included mortality rates and discharge disposition. Secondary outcomes included the number of surgical complications, duration of hospital stay, and ICU length of stay.

Inclusion criteria were age (≥65) at the time of surgery, measurement of laboratory hemoglobin (Hgb) up to 90 days before surgery, and preoperative cognitive screening.

Anemia & Frailty Prevalent Among Surgery Patients  

The researchers included 8,643 patients, 87.4% of whom were White; 50% were women. More than a quarter of patients (26.7%) had anemia, and 36.7% were prefrail or frail.

Elective surgeries included abdominal (33.8%), central nervous system (13.6%), cardiovascular (17.8%), gynecological (4.2%), head/neck (6.5%), and musculoskeletal (24.2%).

Assessing Anemia as a Modifiable Risk Factor

According to the researchers, this study is—to their knowledge—the first to measure and report on the association between anemia and cognitive function. Dr. Howell and colleagues called Hgb the “canary in the coal mine,” even if the Hgb level alone isn’t enough to define the cause of anemia. The study also suggests a correlation between cognitive functioning and anemia, mean corpuscular hemoglobin concentration, and red cell distribution width.

As a result, the study’s findings could be important to preoperative care and research in Alzheimer’s disease. When it comes to the former, the study’s authors suggest an institutionalized approach to anemia management, claiming it may improve both cognitive care and surgical outcomes.

“With established safe and effective treatment regimens, iron deficiency anemia is a modifiable preoperative risk factor that should be addressed before elective surgery,” Dr. Howell and colleagues wrote. “Given the well-defined association between preoperative anemia and postoperative morbidity and mortality, performing elective surgery on an untreated anemic patient should be considered substandard care. An institutionalized approach to presurgical anemia management offers opportunities to improve outcomes, reduce unnecessary transfusions, and possibly impact cognitive care and function in the preoperative setting by improving whole-body iron stores.”