The impact of anemia on one-year amputation-free survival in patients undergoing revascularization for chronic limb-threatening ischemia: a retrospective cohort study
Theuma, Francesca Nickinson, Andrew Cullen, Sarah Patel, Bhavisha Dubkova, Svetlana Davies, Robert Sayers, Robert
Theuma, Francesca
Nickinson, Andrew
Cullen, Sarah
Patel, Bhavisha
Dubkova, Svetlana
Davies, Robert
Sayers, Robert
Abstract
Background: Anemia is potentially associated with increased morbidity and mortality following vascular surgery procedures. This study investigated whether peri-procedural anemia is associated with reduced 1-year amputation-free survival (AFS) in patients undergoing revascularization for chronic limb-threatening ischemia (CLTI).
Methodology: A retrospective analysis of patients diagnosed with CLTI between February 2018-February 2019, who subsequently underwent revascularization, was conducted. Hemoglobin concentration measured at index assessment was recorded and stratified by WHO criteria. Subsequent peri-procedural red blood cell transfusions (RBC) were also recorded. The primary outcome was 1-year AFS. Kaplan Meier survival analysis and Cox's proportional hazard modelling were conducted to assess the effect of anemia and peri-procedure transfusion on outcomes.
Results: 283 patients were analyzed, of which 148 (52.3%) were anemic. 53 patients (18.7%) underwent RBC transfusion. Patients with anemia had a significantly lower 1-year AFS (64.2% vs. 78.5%, P = 0.009). A significant difference in 1-year AFS was also observed based upon anemia severity (P = 0.008) and for patients who received RBC transfusion (45.3% vs 77.0%, P < 0.001). On multivariable analysis, moderately severe anemia was independently associated with increased risk of major amputation/death (aHR 1.90, 95% CI 1.06-3.38, P = 0.030). After adjusting for severity of baseline anemia, peri-procedural RBC transfusion was associated with a significant increase in the combined risk of major amputation/death (aHR 3.15, 95% CI 1.91-5.20, P < 0.001).
Conclusion: Moderately severe peri-procedural anemia and subsequent RBC transfusion are independently associated with reduced 1-year AFS in patients undergoing revascularization for CLTI. Future work should focus on investigating alternative measures to managing anemia in this cohort.
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Date
2022
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Article
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Theuma, F., Nickinson, A., Cullen, S., Patel, B., Dubkova, S., Davies, R., & Sayers, R. D. (2022). The Impact of Anemia on One-Year Amputation-Free Survival in Patients Undergoing Revascularization for Chronic Limb-Threatening Ischemia: A Retrospective Cohort Study. Annals of vascular surgery, 79, 201–207. https://doi.org/10.1016/j.avsg.2021.07.020