Evaluating the Relationship Between Anemia, Transfusion, and Surgical Outcomes in Patients with Surgical Geriatric Cancer: A National Study

BACKGROUND: Anemia and transfusion are associated with poor cancer outcomes. Patients with geriatric cancer often have increased baseline anemia; however, the relationship between anemia, transfusion, and outcomes in this group is unknown. We sought to evaluate the impact of anemia and transfusion on perioperative outcomes in patients with surgical geriatric cancer. STUDY DESIGN: Patients with adult surgical cancer were identified in the American College of Surgeons NSQIP database. Patients were stratified by age, degree of anemia, and primary disease site. Factors associated with 30-day complications were evaluated by logistic regression. RESULTS: A total of 411,710 patients with cancer underwent surgery (older than 65 years: 226,240; older than 75 years: 105,280). The different sites of cancers were as follows: lower gastrointestinal (46.3%), genitourinary (25.7%), hepatobiliary (16.4%), upper gastrointestinal (7.2%), and gynecologic (4.4%). A total of 16,383 patients developed postoperative anemia requiring transfusion (PART). Male sex (odds ratio [OR] 0.71, 95% CI 0.69 to 0.73), older age (OR 0.64, 95% CI 0.60 to 0.69), and genitourinary/gynecologic cancers had fewer severe complications, whereas inpatient rehabilitation (OR 3.66, 95% CI 3.51 to 3.82), higher BMI (OR 1.15, 95% CI 1.10 to 1.24), and PART (OR 1.96, 95% CI 1.86 to 2.06) had more severe complications. PART in patients older than 75 years was most associated with severe complications (OR 1.66, p < 0.001). CONCLUSIONS: Geriatric surgical patients with PART have an increased risk of severe postoperative complications, regardless of anemia severity. Preoperative optimization is imperative in this population. Further prospective data are needed to delineate the highest PART risk.