Prognostic Impact of Anemia and Blood Transfusions on Cardiovascular Outcomes in Patients Undergoing Vascular Surgery: A Scoping Review.

Autor: Nisi F; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. Electronic address: fulvio.nisi@humanitas.it., Ratibondi L; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy., Hagger M; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy., Giustiniano E; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy., Piccioni F; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy., Badalamenti G; Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy., Lepidi S; Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy., D'Oria M; Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2024 Oct 24. Date of Electronic Publication: 2024 Oct 24.
DOI: 10.1053/j.jvca.2024.10.033
Abstrakt: Objective: Prior studies suggest an association of anemia and blood transfusion with increased morbidity and mortality in patients undergoing cardiac surgery. However, the impact of perioperative anemia and blood transfusion on clinical outcomes in patients undergoing major vascular surgery has been poorly defined yet. The primary objectives of this scoping review were to determine the extent of the evidence base that links anemia and blood transfusions to mortality and cardiovascular outcomes in patients undergoing major vascular surgery, and identify recurring themes or gaps in the literature to guide future research.
Methods: A scoping review of the literature from PubMed, Cochrane, and EMBASE databases was conducted up to December 2023 to identify articles related to the impact of anemia and blood transfusions on postoperative cardiovascular outcomes on patients undergoing vascular surgery. Methodology followed the PRISMA Protocols Extension for Scoping Reviews.
Results: Twenty-two articles met the inclusion criteria, including 15 retrospective and 6 observational prospective studies. Anemia definition varied across studies, mainly based on hemoglobin cut-off levels. An association with older age, coronary artery disease, hypertension, diabetes, and other comorbidities was reported. Particularly in peripheral and endovascular aortic surgery, anemia was linked consistently with higher mortality, major adverse cardiac events, and other postoperative complications, such as respiratory and renal issues, surgical site infections, and longer hospital stays, depending on hemoglobin levels. Anemia itself is an important predictor of transfusions. Transfusions in anemic patients were associated with increased mortality, postoperative complications, and increased need for major amputation.
Conclusions: The weight of the evidence suggests that anemia carries a substantial burden of cardiovascular complications, mortality, and multiorgan complications, resulting in increased health care costs. Peripheral and endovascular aortic surgery are affected deeply by the impact of anemia. Anemia itself stands out as a crucial predictor for requiring transfusions. In turn, the effect of transfusion of blood products is associated with worse outcomes and complications.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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