Impact Of Preoperative Anemia Research Articles

Impact of Preoperative Anemia on Short-Term Surgical Outcomes in Patients Undergoing Colectomy for Colon Cancer

Impact of Preoperative Anemia on Short-Term Surgical Outcomes in Patients Undergoing Colectomy for Colon Cancer

The impact of preoperative anemia on red blood cell transfusion in primary and revision hip arthroplasty: A retrospective analysis

Rationale: Lower extremity joint arthroplasty can lead to significant blood loss, and the need for blood transfusion. The use of blood products is associated with a variety of adverse outcomes including infection, circulatory overload, and transfusion reaction. Objectives: The objective of this quality improvement study is to identify the prevalence of preoperative anemia at our institution, and elucidate its impact on perioperative transfusion in elective patients undergoing primary or revision hip arthroplasty. Methods: Data for this study was collected from four databases at our institution. Elective patients undergoing primary or revision hip arthroplasty were selected. Transfusion was defined as the receipt of a red blood cell transfusion on the surgical day through to postoperative day five. The primary outcome was the effect of preoperative anemia on transfusion rates. Results: The overall transfusion rate was 7.6%. Transfusion rates for primary and revision arthroplasty were 5.8% and 18.7% respectively. Patients with a preoperative hemoglobin between 100 and 120 g/L were 4.5 times more likely to be transfused than those with a hemoglobin between 121 and 140 g/L, and 15.4 times more likely than those greater than 140 g/L. Preoperative anemia was common, with 11.5% of all patients having a preoperative hemoglobin of 120 g/L or less. Conclusion: Preoperative anemia was common and was significantly associated with higher transfusion rates. These findings reinforce the need to optimize hip arthroplasty patients prior to surgery, where possible. As a quality control study, these findings may help direct policy regarding the deferral of elective hip arthroplasty patients who are anemic preoperatively.

The impact of preoperative anemia in patients undergoing cardiac surgery

The impact of preoperative anemia in patients undergoing cardiac surgery

Impact of Anemia Severity on Postoperative Complications Following Laparoscopic Hysterectomy

Objective: To determine (1) impact of preoperative anemia on postoperative outcomes and complications following laparoscopic hysterectomy and (2) impact of anemia severity on postoperative outcomes and complications.

Association of preoperative anaemia with postoperative morbidity and mortality: an observational cohort study in low-, middle-, and high-income countries

BackgroundAnaemia is associated with poor postoperative outcomes, but few studies have described the impact of preoperative anaemia in low- and middle- (LMICs), and high-income countries (HICs). MethodsThis was a planned analysis of data collected during an international 7 day cohort study of adults undergoing elective inpatient surgery. The primary outcome was in-hospital death, and the secondary outcomes were in-hospital complications. Anaemia was defined as haemoglobin <12 g dl−1 for females and <13 g dl−1 for males. Hierarchical three-level mixed-effect logistic regression models were constructed to examine the associations between preoperative anaemia and outcomes. ResultsWe included 38 770 patients from 474 hospitals in 27 countries of whom 11 675 (30.1%) were anaemic. Of these, 6886 (17.8%) patients suffered a complication and 198 (0.5%) died. Patients from LMICs were younger with lower ASA physical status scores, but a similar prevalence of anaemia [LMIC: 5072 (32.5%) of 15 585 vs HIC: 6603 (28.5%) of 23 185]. Patients with moderate [odds ratio (OR): 2.70; 95% confidence interval (CI): 1.88–3.87] and severe anaemia (OR: 4.09; 95% CI: 1.90–8.81) were at an increased risk of death in both HIC and LMICs. Complication rates increased with the severity of anaemia. Compared with patients in LMICs, those in HICs experienced fewer complications after an interaction term analysis [LMIC (OR: 0.92; 95% CI: 0.87–0.97) vs HIC (OR: 0.86; 95% CI: 0.84–0.87); P<0.01]. ConclusionsOne-third of patients undergoing elective surgery are anaemic. These patients have an increased risk of complications and death. The prevalence of anaemia is similar amongst patients in LMICs despite their younger age and lower risk profile. Clinical trial registrationISRCTN51817007.

The impact of preoperative anaemia and anaemic subtype on patient outcome in colorectal cancer.

Preoperative anaemia is associated with adverse outcomes in colorectal cancer (CRC). To clarify the reason for this we aimed to comprehensively assess the association of preoperative anaemia with tumour characteristics, host systemic inflammation and nutrition status, and perioperative blood transfusion. We used an integrated database of 592 CRC patients. The association of preoperative anaemic subtype, calculated from haemoglobin and erythrocyte mean corpuscular volume levels, with patient outcome, preoperative serum data relating to systemic inflammation and nutrition and perioperative blood transfusion was analysed. Preoperative anaemia was significantly associated with poorer overall survival and relapse-free survival (RFS); in particular microcytic anaemia had a trend to poorer RFS than other forms of anaemia (P=0.0648). In addition, preoperative anaemia was significantly correlated with right-sided tumours, greater depth of tumour invasion, use of neoadjuvant chemotherapy, poorer prognostic nutritional index and higher modified Glasgow Prognostic Score (mGPS). Microcytic anaemia in particular had a strong association with a greater depth of tumour invasion (P=0.0072) and higher mGPS (P=0.0058) than other causes of anaemia. Perioperative blood transfusion for CRC patients with anaemia was associated with adverse outcomes. Preoperative anaemia, especially microcytic anaemia, was associated with poor patient outcomes, possibly due to poor systemic inflammatory and nutritional status, and it was not improved by perioperative blood transfusion. Our data suggest that preoperative anaemia and the anaemic subtype may serve as an easily available predictor of outcome in CRC.

The impact of preoperative anemia and malnutrition on outcomes in paraesophageal hernia repair.

Patients with a paraesophageal hernia may experience gastroesophageal reflux symptoms and/or obstructive symptoms such as dysphagia. Some patients with large and complex paraesophageal hernias unintentionally lose a significant amount of weight secondary to difficulty eating. A subset of patients will develop Cameron's erosions in the hernia, which contribute to anemia. Given the heterogeneous nature of patients who ultimately undergo paraesophageal hernia repair, we sought to determine if patients with anemia or malnutrition suffered from increased morbidity or mortality. The American College of Surgeons National Surgical Quality Improvement Program datasets from 2011 to 2015 were queried to identify patients undergoing paraesophageal hernia repair. Malnutrition was defined as preoperative albumin < 3.5g/dL. Preoperative anemia was defined as hematocrit less than 36% for females and 39% for males. Thirty-day postoperative outcomes were assessed. A total of 15,105 patients underwent paraesophageal hernia repair in the study interval. Of these patients, 7943 (52.6%) had a recorded preoperative albumin and 13.9% of these patients were malnourished. There were 13,139 (87%) patients with a documented preoperative hematocrit and 23.1% met criteria for anemia. Both anemia and malnutrition were associated with higher rates of complications, readmissions, reoperations, and mortality. This was confirmed on logistic regression. The average postoperative length of stay was longer in the malnourished (6.1 vs. 3.1 days when not malnourished, p < 0.0001) and anemic (4.1 vs. 2.8 days without anemia, p < 0.0001). Malnutrition and anemia are associated with increased morbidity and mortality in patients undergoing paraesophageal hernia repair, as well as a longer length of stay. This information can be used for risk assessment and perhaps preoperative optimization of these risk factors when clinically appropriate.

Preoperative anemia is associated with mortality after carotid endarterectomy in symptomatic patients

ObjectivePreoperative anemia and blood transfusions are associated with worse outcomes after surgery. However, the impact of preoperative anemia and transfusions on outcomes after carotid endarterectomy (CEA) is unknown. MethodsCEA patients from 2011 to 2015 in the American College of Surgeons National Surgical Quality Improvement Program Targeted Vascular module were compared by the presence of preoperative anemia (hematocrit <36%) after stratification by symptom status. Multivariable analysis accounted for differences in baseline characteristics. We included an interaction term in our multivariable model to assess whether the effect of anemia differed significantly between patients who received a perioperative transfusion and those who did not, with 30-day mortality as our primary outcome. ResultsOf 16,068 patients, 6734 (42%) were symptomatic, of whom 1500 (22%) had anemia. Of the 9334 asymptomatic patients, 1935 (21%) had anemia. Both symptomatic and asymptomatic anemic patients were more likely to be transfused perioperatively compared with nonanemic patients, with 7.0% vs 0.4%, and 5.8% vs 0.7% (both P < .001). Among symptomatic patients, those with anemia compared with those without had a higher rate of 30-day mortality (2.5% vs 0.7%; P < .001). After adjustment, anemic symptomatic patients had a higher 30-day mortality risk (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.9-5.0; P < .001) compared with nonanemic symptomatic patients. In addition, in symptomatic patients, we found a significant interaction between anemia and perioperative transfusion on the outcome of 30-day mortality (P = .004), with a higher risk in perioperatively transfused symptomatic patients with anemia (OR, 7.8; 95% CI, 3.4-18.0; P < .001) than in symptomatic patients with anemia who did not receive a perioperative transfusion (OR, 2.3; 95% CI, 1.4-3.9; P = .002). In asymptomatic patients, anemic and nonanemic patients had comparable 30-day mortality rates (0.9% vs 0.6%; P = .2). After adjustment, anemia was not associated with 30-day mortality in asymptomatic patients (OR, 1.0; 95% CI, 0.5-2.0; P = .9), nor did we identify an interaction between anemia and perioperative transfusion in asymptomatic patients (P = .1). Patients who received a preoperative transfusion had a higher 30-day mortality rate than anemic patients not receiving preoperative transfusion in both symptomatic (n = 31, 9.7% vs 2.5%; P = .04) and asymptomatic patients (n = 21, 9.5% vs 0.9%; P = .02). ConclusionsPreoperative anemia is a risk factor for 30-day mortality after CEA in symptomatic patients but not in asymptomatic patients. These results should be factored into the selection of symptomatic patients for CEA and dissuade treatment of asymptomatic patients scheduled for CEA who need a preoperative transfusion.

P3969A more restrictive transfusion policy modifies the impact of preoperative anemia on strokes and other outcomes after cardiac surgery in adults

P3969A more restrictive transfusion policy modifies the impact of preoperative anemia on strokes and other outcomes after cardiac surgery in adults

P2483Predictors and clinical impact of preoperative anemia in patients undergoing transcatheter aortic valve replacement

P2483Predictors and clinical impact of preoperative anemia in patients undergoing transcatheter aortic valve replacement

Impact of Preoperative Anemia on Outcomes in Adults Undergoing Elective Posterior Cervical Fusion.

Study Design:Retrospective analysis of prospectively collected data.Objectives:Few studies have investigated the role of preoperative anemia on postoperative outcomes of posterior cervical fusion. This study looked to investigate the potential relationship between preoperative anemia and postoperative outcomes following posterior cervical spine fusion.Methods:Data from patients undergoing elective posterior cervical fusions between 2005 and 2012 was collected from the American College of Surgeons National Surgical Quality Improvement Program database using inclusion/exclusion criteria. Multivariate analyses were used to identify the predictive power of anemia for postoperative outcomes.Results:A total of 473 adult patients undergoing elective posterior cervical fusions were identified with 106 (22.4%) diagnosed with anemia preoperatively. Anemic patients had higher rates of diabetes (P = .0001), American Society of Anesthesiologists scores ≥3 (P < .0001), and higher dependent functional status prior to surgery (P < .0001). Intraoperatively, anemic patients also had higher rates of neuromuscular injuries (P = .0303), stroke (P = .013), bleeding disorders (P = .0056), lower albumin (P < .0001), lower hematocrit (P < .0001), and higher international normalized ratio (P = .002). Postoperatively, anemic patients had higher rates of complications (P < .0001), death (P = .008), blood transfusion (P = .001), reoperation (P = .012), unplanned readmission (P = .022), and extended length of stay (>5 days; P < .0001).Conclusions:Preoperative anemia is linked to a number of postoperative complications, which can increase length of hospital stay and increase the likelihood of reoperation. Identifying preoperative anemia may play a role in optimizing and minimizing the complication rates and severity of comorbidities following posterior cervical fusion.

Impact of Preoperative Anemia and Postoperative Hemoglobin Drop on the Incidence of Acute Kidney Injury and In-Hospital Mortality in Patients With Type B Acute Aortic Syndromes Undergoing Thoracic Endovascular Aortic Repair.

The impact of preoperative anemia and postoperative hemoglobin (Hb) drop on the incidence of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR) for type B acute aortic syndromes (AAS) as well as their prognostic value is unknown. This retrospective study included 144 patients with type B AAS undergoing TEVAR at our center. Preoperative anemia was classified as no/mild (Hb ≥ 12.0 g/dL in men; ≥11.3 g/dL in women), moderate (Hb 10.80-11.99 g/dL in men; 10.23-11.29 g/dL in women), and severe (<10.80 g/dL in men; <10.23 g/dL in women). Postoperative Hb drop was classified as mild (<2 g/dL), moderate (2-4 g/dL), and severe (>4 g/dL). End points of the study were postoperative AKI and in-hospital mortality. Postoperative AKI was higher in the severe and moderate anemia groups than the no/mild anemia group (63.2%, 52.0%, and 31.0%, respectively, P = .01). In-hospital mortality and AKI were higher in patients with severe postoperative Hb drop (40.9% and 86.4%) than patients with moderate (6.9% and 36.2%) and mild (4.7% and 25.0%) postoperative Hb drop (both P < .001). Postoperative Hb drop (odds ratio [OR]:1.67, P = .036), postoperative Hb levels (OR: 0.57, P = .025), and mesenteric ischemia (OR: 4.65, P = .044) were identified as independent predictors of in-hospital mortality. Preoperative Hb (OR: 0.26, P = .001), postoperative Hb drop (OR: 4.34, P < .001), contrast medium (OR: 1.82, P = .004), and diabetes mellitus (OR: 3.79, P = .001) were independent predictors of AKI. At follow-up, anemia and postoperative Hb drop were not associated with increased mortality. Preoperative Hb and postoperative Hb drop were significant risk factors for AKI. Postoperative Hb drop and Hb levels predicted in-hospital mortality.

Blood Transfusion Requirement and Not Preoperative Anemia Are Associated with Perioperative Complications Following Intracorporeal Robot-Assisted Radical Cystectomy.

To assess the prevalence of preoperative anemia and the impact of preoperative anemia and blood transfusion requirement on 30- and 90-day complications in a cohort of patients undergoing robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC). IRARC was performed on 166 patients between June 2011 and March 2016. Prospective data were collected for patient demographics, clinical and pathologic characteristics, perioperative variables, transfusion requirements, and hospital length of stay. Thirty- and 90-day complications were classified according to the modified Memorial Sloan Kettering Cancer Center Clavien-Dindo system. Preoperative anemia was common (43.4%) and greatest in patients receiving neoadjuvant chemotherapy (48.6%) (p < 0.001). Patients with preoperative anemia were significantly more likely to have an Ileal conduit (p = 0.033), higher cystectomy stage (≥pT3) (p = 0.028), and a lower lymph node yield (p = 0.031). Preoperative anemia was not associated with increased perioperative morbidity but was associated with the requirement for blood transfusion (p = 0.001). Blood transfusion required in 20.4% of patients with intraoperative and postoperative blood transfusion rate was 10.2% and 13.9%, respectively. The 30-day all complication rate and 30-day major complication rate were 55.4% and 15.7%, respectively, while 90-day all complication rate and 90-day major complication rate were 65.7% and 19.3%, respectively. Intraoperative blood transfusion was not associated with increased complications, but postoperative blood transfusion requirement was independently associated with perioperative morbidity: all 30-day complications (p = 0.003), all 90-day complications (p = 0.009), and 90-day major complications (p = 0.004). The presence of preoperative anemia in patients undergoing iRARC is not associated with increased surgical risk, although preoperative anemic patients were significantly more likely to require blood transfusion. Blood transfusion requirement and specifically postoperative blood transfusion are independently associated with perioperative morbidity and are an important factor for the optimization of postoperative outcomes.

Prognostic impact of preoperative anemia on non-muscle-invasive bladder carcinoma treated with GreenLight laser vaporization.

In this study, we aimed to evaluate the impact of preoperative anemia (PA) on oncological outcomes among patients with non-muscle-invasive bladder cancer (NMIBC) treated with GreenLight laser vaporization of bladder tumor (PV-BT). Between January 2010 and December 2015, 407 patients with NMIBC who underwent PV-BT surgery were stratified into normal and anemia groups based on the World Health Organization classification (anemia cutoff value: hemoglobin level, <13.0mg/dL in men and <12.0mg/dL in women). The Student's t test and chi-square test were performed to assess the effects of PA on clinical and pathological characteristics of patients with NMIBC. The Kaplan-Meier method was used to investigate the influence of PA on oncological survival outcomes. Before PV-BT, 139 patients (34.2%) were anemic. No significant differences in age, sex, smoking habit, tumor size, focality, grade, and stage were found between the anemia and normal groups. At a median follow-up period of 32.5months (range, 8-60months), 74 patients (18.2%) had urothelial recurrence, 30 (7.4%) died from any cause, and 21 (5.2%) died from bladder cancer. In the Kaplan-Meier analysis, preoperative anemia was significantly associated with decreased cancer-specific survival (CSS) and overall survival (OS) of the patients with NMIBC. However, recurrence-free survival (RFS) showed no statistically significant difference between the PA and normal groups. The preoperative anemic patients with NMIBC who underwent PV-BT surgery had worse CSS and OS. PA can be a useful and cost-effective prognostic marker in the clinical practice for NMIBC treatment.

The Prevalence and Impact of Preoperative Anemia in Patients Undergoing Cardiac Surgery for Rheumatic Heart Disease.

Many observational studies have demonstrated an association between preoperative anemia and adverse outcomes after cardiac surgery. However, there is a paucity of data on the impact of anemia in patients undergoing cardiac surgeries for rheumatic heart disease (RHD). This study was designed to examine the prevalence and impact of preoperative anemia in patients undergoing cardiac surgery for RHD. Retrospective observational data analysis. Tertiary-care hospital. 335 consecutive patients undergoing cardiac surgery for RHD from January 2009 to November 2014. No interventions. Prevalence of preoperative anemia as per World Health Organization (WHO) definition was 51.95%. Mild and moderate anemias were present in 33.15% and 18.80%, respectively. The primary endpoint was in-hospital mortality, with an incidence of 26 (6.9%); the incidence of mortality in non-anemic, mildly anemic, and moderately anemic patients was 5.59%, 4.50%, and 19.04% (p = 0.003), respectively. Patients with moderate anemia utilized an average of 3 units of packed cells compared to 1 in non-anemic patients (p = 0.0001). A multiple regression analysis was performed to predict mortality from variables including anemia, EuroSCORE II, and perioperative blood transfusion. On adjusting for EuroSCORE II and severity of anemia, perioperative packed cell transfusion was associated with significant odds (odds ratio 2.218; confidence interval 1.517-2.986; p<0.0001) for mortality. In patients undergoing cardiac surgery for RHD, there was high prevalence of preoperative anemia. Despite higher transfusion rates in moderately anemic patients, they had significantly lower Hb on CPB and in the postoperative period. Perioperative packed cell transfusion was associated significantly with mortality.

Impact of Preoperative Anemia on Perioperative Outcomes in Adults Undergoing Elective Posterior Cervical Fusion

Anemia has been shown to be an independent risk factor of postoperative mortality and morbidity in several surgical procedures. Preoperative anemia is of particular concern in posterior cervical fusion (PCF) due to the frequent diagnosis of spinal stenosis associated with this procedure and the substantial metabolic demand of the spinal cord. No previous studies have evaluated the effect of preoperative anemia on outcomes in PCF.

Impact of Preoperative Anaemia and Blood Transfusion on Postoperative Outcomes in Gynaecological Surgery.

ObjectiveTo evaluate the effect of preoperative anaemia and blood transfusion on 30-day postoperative morbidity and mortality in patients undergoing gynecological surgery.Study DesignData were analyzed from 12,836 women undergoing operation in the American College of Surgeons National Surgical Quality Improvement Program. Outcomes measured were; 30-day postoperative mortality, composite and specific morbidities (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thrombosis, or major bleeding). Multivariate logistic regression models were performed using adjusted odds ratios (ORadj) to assess the independent effects of preoperative anaemia (hematocrit <36.0%) on outcomes, effect estimates were performed before and after adjustment for perioperative transfusion requirement.ResultsThe prevalence of preoperative anaemia was 23.9% (95%CI: 23.2–24.7). Adjusted for confounders by multivariate logistic regression; preoperative anaemia was independently and significantly associated with increased odds of 30-day mortality (OR: 2.40, 95%CI: 1.06–5.44) and composite morbidity (OR: 1.80, 95%CI: 1.45–2.24). This was reflected by significantly higher adjusted odds of almost all specific morbidities including; respiratory, central nervous system, renal, wound, sepsis, and venous thrombosis. Blood Transfusion increased the effect of preoperative anaemia on outcomes (61% of the effect on mortality and 16% of the composite morbidity).ConclusionsPreoperative anaemia is associated with adverse post-operative outcomes in women undergoing gynecological surgery. This risk associated with preoperative anaemia did not appear to be corrected by use of perioperative transfusion.

Impact of Preoperative Anaemia on Outcome in Elective On-Pump Cardiac Surgery

Summary Introduction. Anaemia is a clinically important and increasingly frequent finding in cardiac surgery. Whether preoperative anaemia is an independent risk factor for adverse outcomes after elective cardiac surgery is still under discussion. We analysed prevalence of preoperative anaemia and its influence to outcome in patients undergoing elective on-pump cardiac surgery. Aim of the Study. To analyse preoperative anaemia and its influence to outcome in patients undergoing elective cardiac surgery. Material and Methods. Prospective study was done from October 2013 to January 2014 at the Cardiac Surgery Centre of Pauls Stradins Clinical University Hospital. Data were collected on 192 patients who underwent elective on-pump cardiac surgery. The prevalence of preoperative anaemia was defined as haemoglobin (Hb) for men &lt; 130 g/l, for women &lt; 120 g/l. Surgical bleeding was found for 17 patients during re-operation, those were excluded from future analysis. Consequently, 175 were divided into two groups: anaemic (n=69) and control group (n=106). Anaemia relationships with haemotransfusions, postoperative complications as acute heart failure, infections, atrial fibrillation, acute kidney injury (AKI) and length of mechanical ventilation and stay in hospital were obtained. Results. The overall prevalence of preoperative anaemia was 39%. Preoperative Hb values were 111 ± 13 g/l, MCHC 329 ± 12 g/l, MCV 86 ± 8 fl in anaemic group and in a control group Hb 140 ± 11 g/l, MCHC 335 ± 8 g/l, MCV 89 ± 9 fl (p &lt; 0,001; p &lt; 0,001; p = 0,01). Anaemic patients in 80% received red blood cell (RBC) transfusions 586 ± 801 ml and 47% in control group, p &lt; 0,0001. Fresh frozen plasma (FFP) and Cryoprecipitate (Cryo) transfused volumes did not differ statistically between groups (p = 0,15; p = 0,2). Sensitivity and specificity of preoperative anaemia to haemotransfusions: area under curve for RBC transfusions 0,71, for FFP 0,57, for Cryo 0,44. Hb levels before and 24 hours after surgery correlated with RBC transfusions (r = - 0,4, - 0,5; p &lt; 0,001). Anaemia is an independent risk factor for postoperative infection (p=0.04; OR 4.2; 95% C.I. 1.2-16.7) and AKI (p=0,02; OR 2.3; 95% C.I. 1.1-4.6). RBC transfusion volume is adjusted to postoperative infections and AKI, respectively, p = 0.004 and p = 0.01. Anaemic patients had statistically longer mechanical lung ventilation (p = 0.02) and stay in hospital (p = 0.04). Conclusions. Preoperative anaemia, mainly normocytic normochromic (72%) and microcytic hypochromic (13%), is observed in 39%. Anaemic patients received major RBC transfusions to compare with non-anaemic patients. Preoperative anaemia and volume of RBC transfused are associated with development of AKI and infections postoperatively. Preoperative anaemia prolongs mechanical lung ventilation and in-hospital stay.

Impact of preoperative anemia on relapse and survival in breast cancer patients.

BackgroundPrevious studies have shown that preoperative anemia is correlated with the prognoses of various solid tumors. This study was performed to determine the effect of preoperative anemia on relapse and survival in patients with breast cancer.MethodsA total of 2960 patients with breast cancer who underwent surgery between 2002 and 2008 at the Sun Yat-sen University Cancer Center (Guangzhou, PR China) were evaluated in a retrospective analysis. A total of 2123 qualified patients were divided into an anemic group [hemoglobin (Hb) < 12.0 g/dL, N = 535)] and a nonanemic group (Hb ≥ 12.0 g/dL, N = 1588). The effects of anemia on local relapse-free survival (LRFS), lymph node metastasis-free survival (LNMFS), distant metastasis-free survival (DMFS), relapse-free survival (RFS), and overall survival (OS) were assessed using Kaplan–Meier analysis. Independent prognostic factors were identified in the final multivariate Cox proportional hazards regression model.ResultsAmong the 2123 women who qualified for the analysis, 535 (25.2%) had a Hb level < 12.0 g/dL. The Kaplan–Meier curves showed that anemic patients had worse LRFS, LNMFS, DMFS, RFS, and OS than nonanemic patients, even in the same clinical stage of breast cancer. Cox proportional hazards regression model indicated that preoperative anemia was an independent prognostic factor of LRFS, LNMFS, DMFS, RFS, and OS for patients with breast cancer.ConclusionsPreoperative anemia was independently associated with poor prognosis of patients with breast cancer.

AB87. Evaluating the impact of preoperative anemia on the prognosis of upper tract urothelial carcinoma following radical nephroureterectomy

ObjectivesTo identify prognostic predictors of upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU), we tested the hypothesis that preoperative anemia could be a potential predictor of the prognosis of UTUC.Patients and methodsClinical and pathological data on 686 patients with UTUC who underwent RNU at Peking University First Hospital, Beijing, China, between 1990 and 2012 were retrospectively analyzed. The chi-square test was used to analyze the associations with preoperative anemia, and the Kaplan-Meier test and Cox proportional hazards regression models were used to perform survival analysis.ResultsPreoperative anemia was associated with gender, lymph node metastasis, increased tumor grade, concomitant CIS, tumor necrosis, renal function and age. Preoperative anemia was an independent risk factor for overall mortality (HR =1.861) and cancer-specific mortality (HR =1.688).ConclusionsThe preoperative anemia is an independent risk factor for cancer-specific mortality and overall mortality. Therefore, hemoglobin levels should be considered during patient counseling and decision-making for further therapy.