The Interplay between Preoperative Anemia and Postoperative Blood Transfusion on Survival following Fenestrated Aortic Aneurysm Repair
| Autor: | Boylan Luke, Nandhra Sandip, Williams Robin, Prentis James, Scott Emma, Nesbitt Craig, McCaslin James, Priona Georgia |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Blood transfusion Time Factors Databases Factual Anemia medicine.medical_treatment Myocardial Infarction Renal function 030204 cardiovascular system & hematology Endovascular aneurysm repair Risk Assessment 030218 nuclear medicine & medical imaging 03 medical and health sciences Aortic aneurysm Blood Vessel Prosthesis Implantation Hemoglobins 0302 clinical medicine Aneurysm Risk Factors Medicine Humans Blood Transfusion Aged Retrospective Studies Aged 80 and over business.industry Mortality rate Hazard ratio Endovascular Procedures General Medicine Length of Stay medicine.disease Surgery Treatment Outcome Female Cardiology and Cardiovascular Medicine business Biomarkers Aortic Aneurysm Abdominal |
| Zdroj: | Annals of vascular surgery. 70 |
| ISSN: | 1615-5947 |
| Popis: | Background Anemia is associated with a higher mortality following standard endovascular aortic repair (EVAR). This study evaluates the impact of anemia on fenestrated endovascular aneurysm repair (FEVAR) for complex aneurysm (AAA) repair. Methods All elective FEVARs performed between 2010 and 2018 at a tertiary vascular center were analyzed. Anemia was defined as a preoperative hemoglobin (Hb) of Results In total, 132 FEVAR patients were followed up for 3.7 (2.2) years. Thirty-eight patients were anemic [average Hb of 112 (13) g/L]. Groups were comparable for age, AAA diameter, body mass index, and comorbidity. Anemic patients had a lower baseline estimated glomerular filtration rate [64.1 (23.2) vs. 70.9 (18.8) mL/min/1.73 m2, P = 0.022] and a longer procedural time [242 (103) vs. 195.4 (88) min, P = 0.009] with no difference in the number of fenestrations (P = 0.696). Kaplan–Meier analysis demonstrated a higher mortality (log-rank P = 0.03) with 40% deceased versus 21% nonanemic (P = 0.04) at the end of follow-up. Anemic patients had more postoperative myocardial infarctions (MIs) (4 vs. 2, P = 0.037) and a longer LOS [9.2 (7.1) vs. 6.3 (6.8) days, P = 0.001]. Increasing Hb increased the likelihood of survival [hazard ratio, HR −0.8 (0.65–0.94), P = 0.038]. Postoperative transfusion was adversely associated with survival [HR 3.65 (1.05–12.8), P = 0.043]. Conclusions Anemia appears to be associated with an increased rate of postoperative MI, LOS, frequency of blood transfusion, and mortality rate following FEVAR but this surpassed by postoperative blood transfusion. Optimization of preoperative Hb should be considered as a potential target for improvements in clinical outcomes and hypothetically a consequential reduction in postoperative red blood cell transfusion need. |
| Databáze: | OpenAIRE |
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