Association Between Preoperative Anemia and Cognitive Function in a Large Cohort Study of Older Patients Undergoing Elective Surgery.

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY
Anesthesia and analgesia Pub Date : 2025-01-01 Epub Date: 2024-07-10 DOI:10.1213/ANE.0000000000006998
Keith Howell, Cynthia Garvan, Shawna Amini, Reed W Kamyszek, Patrick Tighe, Catherine C Price, Bruce D Spiess
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引用次数: 0

Abstract

Background: The etiology of anemia has tremendous overlap with the disease states responsible for cognitive decline. We used data from a perioperative database of older adults undergoing elective surgery with anesthesia to (1) examine relationships among preoperative anemia blood markers, preoperative screeners of cognitive function, and chronic disease status; and (2) examine the relationship of these factors with operative outcomes. The primary goal of this study was to investigate the association between preoperative anemia blood markers and cognition measured by a preoperative cognitive screener. Secondary goals were to (1) examine the relationship between preoperative anemia blood markers and chronic disease states (ie, American Society of Anesthesiologists [ASA] and frailty), and (2) investigate the relationship of preoperative anemia blood markers and cognition with operative outcomes (ie, discharge disposition, 1-year mortality, number of surgical complications, length of hospital stay, and length of intensive care unit [ICU] stay).

Methods: Data were collected at the University of Florida Health Shands Presurgical Center and the Perioperative Cognitive Anesthesia Network clinic within the electronic medical record. Patients 65 years of age or older were included if they had a preoperative hemoglobin (Hgb) value and a preoperative screening. Nonparametric methods were used for bivariate analysis. Logistic regression was used for the simultaneous examination of variables associated with nonhome discharge and 1-year mortality. Primary outcomes were discharge disposition and 1-year mortality. Secondary outcomes were number of surgical complications and length of hospital and ICU stay.

Results: Of 14,795 patients cognitively assessed, 8643 met the inclusion criteria. Of these, 26.7% were anemic, with 16.8%, 9.5%, and 0.4% having mild, moderate, and severe anemia, respectively. The Spearman correlation coefficient [95% confidence interval, CI] between the Hgb level and the clock drawing time (CDT) was -.15 [-.17 to -.13] ( P < .0001) indicating that a lower Hgb level was associated with cognitive vulnerability. Hgb was also negatively correlated with the ASA physical status classification, patient Fried Frailty Index, and hospital and ICU length of stay. In the multivariable model, age, surgical service, ASA and Fried Frailty Index significantly predicted nonhome discharge. Furthermore, age, surgical service, ASA, Fried Frailty Index, and Hgb independently predicted death within 1 year of surgery. The odds of death, adjusted for ASA, Fried Frailty, and covariates, were 2.7 times higher for those in the mild anemic group compared to those who were not anemic (odds ratio [OR], 2.7, 95% CI, [2.1-3.5]). The odds of death, adjusted for ASA, Fried Frailty, and covariates, were 3.6 times higher for those in the moderate/severe anemic group compared to those who were not anemic (OR, 3.6, 95% CI, [2.7-4.9]).

Conclusions: In this first medicine study, we established relationships among anemia, preoperative markers of frailty and cognition, and chronic disease states in a large cohort of older patients undergoing elective surgery in a large tertiary medical center. We found that anemia, cognitive vulnerability, and chronic health disease states predicted death within 1 year of surgery, and that these preoperative factors negatively contribute to surgical outcomes such as time in the ICU, length of hospital stay, nonhome discharge, and 1-year mortality. The World Health Organization (WHO) 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. 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. With established safe and effective treatment regimens, iron deficiency anemia is a modifiable preoperative risk factor that should be addressed before elective surgery.

一项针对接受择期手术的老年患者的大型队列研究中,术前贫血与认知功能之间的关系。
背景:贫血的病因与导致认知功能下降的疾病状态有很大的重叠。我们利用接受择期麻醉手术的老年人围手术期数据库中的数据:(1)研究术前贫血血液标记物、术前认知功能筛查指标和慢性疾病状态之间的关系;(2)研究这些因素与手术结果之间的关系。本研究的首要目标是研究术前贫血血液标记物与术前认知功能筛查器所测认知功能之间的关系。次要目标是:(1) 研究术前贫血血液标记物与慢性疾病状态(即美国麻醉医师协会 [ASA] 和虚弱)之间的关系;(2) 研究术前贫血血液标记物和认知与手术结果(即出院处置、1 年死亡率、手术并发症数量、住院时间和重症监护室 [ICU] 住院时间)之间的关系:在佛罗里达大学健康 Shands 手术前中心和围手术期认知麻醉网络诊所的电子病历中收集数据。如果 65 岁或以上的患者在术前有血红蛋白 (Hgb) 值并进行了术前筛查,则将其纳入研究范围。双变量分析采用非参数方法。逻辑回归用于同时检查与非居家出院和 1 年死亡率相关的变量。主要结果是出院处置和 1 年死亡率。次要结果是手术并发症的数量以及住院时间和重症监护室的停留时间:在接受认知评估的 14795 名患者中,有 8643 人符合纳入标准。其中 26.7% 的患者贫血,轻度、中度和重度贫血患者分别占 16.8%、9.5% 和 0.4%。血红蛋白水平与时钟绘制时间(CDT)之间的斯皮尔曼相关系数[95%置信区间,CI]为-.15[-.17 至-.13](P < .0001),表明较低的血红蛋白水平与认知脆弱性相关。血红蛋白还与 ASA 身体状况分类、患者弗里德虚弱指数、住院时间和重症监护室住院时间呈负相关。在多变量模型中,年龄、手术服务、ASA 和 Fried Frailty 指数可显著预测非居家出院。此外,年龄、手术服务、ASA、Fried Frailty 指数和血红蛋白也可独立预测术后一年内的死亡。经ASA、Fried Frailty指数和辅助变量调整后,轻度贫血组患者的死亡几率是无贫血组患者的2.7倍(几率比[OR],2.7,95% CI,[2.1-3.5])。经ASA、Fried Frailty和辅助变量调整后,中度/重度贫血组患者的死亡几率是不贫血组患者的3.6倍(OR,3.6,95% CI,[2.7-4.9]):在这项首次医学研究中,我们确定了在一家大型三级医疗中心接受择期手术的大批老年患者中贫血、术前虚弱和认知标记物以及慢性疾病状态之间的关系。我们发现,贫血、认知脆弱和慢性疾病状态预示着手术后 1 年内的死亡,这些术前因素对手术结果(如在重症监护室的时间、住院时间、非家庭出院和 1 年死亡率)有负面影响。世界卫生组织(WHO)和许多学术医学会都敦促采用患者血液管理(PBM)规范,但贫血并没有作为术前风险因素进行常规优化。鉴于术前贫血与术后发病率和死亡率之间存在明确的关联,对未经治疗的贫血患者实施择期手术应被视为不合标准的护理。有了安全有效的治疗方案,缺铁性贫血是一种可改变的术前风险因素,应在择期手术前加以解决。
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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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