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Impact Of Postoperative Anemia And Transfusion In Patients Undergoing Complex And Fenestrated-branched Endovascular Aortic Repair
Alexander D. Dibartolomeo, MD
1, Arunvijay R. Iyer, BA
1, Li Ding, MD, MPH
1, Anastasia Plotkin, MD
2, Sukgu M. Han, MD, MS
1, Gregory A. Magee, MD, MSc
1.
1University of Southern California, Los Angeles, CA, USA,
2University of Southern California, Pasadena, CA, USA.
OBJECTIVES:While anemia in patients undergoing endovascular aneurysm repair (EVAR) has been associated with negative outcomes, the impact of transfusion remains unclear and controversial. This study evaluates the impact of postoperative anemia and red blood cell transfusion in patients undergoing complex and fenestrated-branched EVAR (FB-EVAR).
Methods:The Society for Vascular Surgery Vascular Quality Initiative was queried for patients undergoing FB-EVAR with incorporation of one or more viscerorenal vessels from 2014-2020. Patients were grouped by postoperative nadir hemoglobin (Hgb) level (<7, 7-8, 8-9, 9-10, >10 g/dL), then stratified by transfusion status. The primary endpoint was major adverse cardiac events (MACE), including myocardial infarction, heart failure, dysrhythmia, and stroke. Secondary endpoints included in-hospital mortality and 1-year survival.
Results:In total, 4,966 patients met criteria for analysis including 9% with Hgb <7, 14% with Hgb 7-8, 16% with Hgb 8-9, 17% with Hgb 9-10, and 43% with Hgb >10. The rate of transfusion correlated inversely by lowest Hgb level: 89%, 74%, 40%, 21%, 6%, respectively. MACE, in-hospital mortality and 1-year survival correlated with Hgb level, with the worst outcomes in the lowest level. MACE was significantly higher for patients that received transfusion across all Hgb groups: 33.42% vs 15.63%, P=0.048; 23.38% vs 14.04%, P=0.008; 18.69% vs 5.97%, P<0.0001; 14.44% vs 6.55%, P=0.0006, and 13.08% vs 3.43%, P<0.0001, respectively. In-hospital mortality was significantly higher for patients that received transfusion in all groups except Hgb <7. On multivariable analysis transfusion remained an independent predictor for MACE and in-hospital mortality.
Conclusions:Postoperative anemia in patients undergoing FB-EVAR is associated with worse outcomes. Rather than attenuating the negative impact of anemia, transfusion is independently associated with increased MACE and in-hospital mortality. This data suggests transfusion should be used judiciously and a randomized study is justified to determine the optimal transfusion threshold for patients undergoing FB-EVAR.
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