Risk Associated with Preoperative Anemia in Noncardiac Surgery

Abstract

DESPITE improved surgical techniques, the publication of consensus guidelines1 and the use of improved anesthetic techniques, postoperative mortality has remained unchanged over the past decades.2 This report focuses on preoperative anemia, which is emerging as a common and important public health issue.3–6 Under the assumption that the results of the Transfusion Requirements in Critical Care trial are transferable to noncardiac surgery,7 clinicians have been encouraged to tolerate greater degrees of anemia. However, the Transfusion Requirements in Critical Care trial has been criticized because of treatment misalignment that makes the results difficult to transfer to other settings.8 Preoperative anemia is an important issue because it is the strongest predictor of transfusions of blood components,9–12 which carry many attendant risks7,13 and likely increases morbidity. Second, anemia has been associated with harmful effects over and above the increased risk imparted by the increased need for transfusion. A variety of studies in general and elderly populations, in patients with coronary disease14 and congestive heart failure,15 and in cardiac16–18 and noncardiac surgery.19 have linked anemia with increased mortality.