Preoperative anemia among elderly patients undergoing major abdominal surgery is linked to poorer postoperative outcomes and diminished quality of life (QoL), according to new research conducted at Singapore General Hospital. The study highlights the urgent need for awareness and management of anemia to improve recovery trajectories.
Leading the study, researchers investigated how preoperative anemia affects QoL, particularly through the perspectives of older adults scheduled for major abdominal procedures. Drawing from data collected between 2017 and 2021, the study examined 469 patients, 176 of whom were identified as having some form of anemia—38%. Among these, the majority presented with mild anemia. The findings suggest significant correlations between anemia severity and QoL outcomes as quantified using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) and EuroQol Visual Analogue Scale (EQ-VAS) instruments.
Preoperative anemia isn't uncommon among older adults, with estimates indicating over 10% of individuals aged 65 and older experience this condition. Notably, the incidence rises markedly before major surgeries—particularly gastrointestinal procedures—where as many as 45% of patients over 70 may present with anemia. The significant surgical stress posed by such procedures exacerbates existing vulnerabilities characteristic of elderly patients.
Earlier studies have demonstrated the considerable impact of anemia on postoperative morbidity, linking it to several health risks, including prolonged hospital stays and higher rates of complications. Expanding upon previous work, this study took a focused approach to assess QoL, thereby shedding light on additional long-term ramifications of preoperative anemia.
The methodology included thorough evaluations customized for older patients, assessing QoL through primarily validated instruments at multiple time points: baseline, 1 month, 3 months, and 6 months post-surgery. Importantly, findings demonstrated pronounced improvements across all patient groups over time as the severity of anemia decreased. This trend highlights the potential benefits derived from interventions aimed at managing anemia prior to surgery.
Results illustrated stark differences between QoL outcomes for patients experiencing varying levels of anemia. For example, moderate-to-severe anemia was associated with heightened instances of issues related to self-care, mobility, pain/discomfort, and increased levels of anxiety and depression. At baseline, these patients reported lower mean EQ-VAS scores—77 on average, compared to higher scores observed for non-anemic patients.
Anemia's ramifications extend beyond the immediate postoperative phase. Data indicated persistent differences over time; patients without anemia consistently demonstrated elevated EQ-VAS scores, indicating varying degrees of health improvement compared to their anemic counterparts. Consequently, evidence suggests proactive measures surrounding anemia management may generate significant benefits not limited to surgical outcomes but inclusive of overall QoL.
Describing the findings, researchers concluded, "Preoperative anemia is associated with a significant decrease in QoL based on EQ-VAS. Recognizing and managing preoperative anemia may improve the recovery of elderly patients undergoing major abdominal surgery." These insights are valuable for healthcare providers involved with preoperative care, emphasizing the necessity for screening and addressing anemia proactively.
Given the high prevalence of anemia within this demographic, and the associated adverse postoperative outcomes highlighted, there is clear relevance for incorporating anemia screening as part of routine preoperative evaluation protocols.
With mounting evidence linking anemia management to enhanced recovery experiences, this research advocates for health systems to develop clear strategies aimed at optimizing preoperative anemia prior to elective surgeries. Future studies should build on these findings to explore effective methods for improving patient outcomes and broadening the scope of care for vulnerable populations undergoing surgical interventions.