Impacto de la anemia preoperatoria en la revascularización de pacientes con isquemia crítica de la extremidad inferior

espanolIntroduccion. La anemia preoperatoria es un factor de riesgo establecido en enfermedades cardiovasculares y en procedimientos quirurgicos; sin embargo, aun no se ha establecido fehacientemente su papel en cirugia vascular periferica. Este trabajo evalua el impacto de la anemia preoperatoria en pacientes sometidos a revascularizacion por isquemia critica de la extremidad inferior. Material y Metodos. Se diseno un estudio restrospectivo observacional de pacientes revascularizados por isquemia critica en el Hospital Clinico Universitario de Valladolid. Se clasifico a los pacientes en dos grupos segun el valor de hemoglobina preoperatoria, estableciendo el punto de corte en 10 g/dL. Se compararon ambos grupos para estimar diferencias en cuanto a amputacion mayor, exitus, supervivencia libre de amputacion mayor, estancia postoperatoria y complicaciones. Resultados. De los 672 pacientes incluidos en el trabajo, 66 (9,9%) presentaron un valor de hemoglobina inferior a 10 g/dL. El grupo de pacientes anemicos presento mayor mortalidad a 30 dias(13,6% versus 5,4%) como a un ano(42,6% versus 14,7%); la tasa de amputacion mayor tambien fue significativamente peor a 30 dias (21,2% versus 8,3%) y un ano (36,4% versus 20,7%). La supervivencia libre de amputacion mayor fue peor en pacientes anemicos (68%, 62%, 56%, 50% y 47% versus 38%, 31%, 31%, 25% y 25% a 1, 2, 3, 4 y 5 anos). Asimismo, la estancia media fue superior en los pacientes anemicos (20,09 +/- 19,38 versus 14,96 +/- 12,03 dias). Conclusion. La anemia preoperatoria en pacientes revascularizados por isquemia critica de la extremidad inferior se asocia a peores resultado clinicos en terminos de muerte y amputacion mayor, tanto a corto como a largo plazo, asi como a mayor tasa de complicaciones cardiorespiratorias. EnglishIntroduction. Preoperative anemia is an established risk factor for cardiovascular disease and surgical procedures; however, has not yet been convincingly established its role in peripheral vascular surgery. This paper evaluates the impact of preoperative anemia in patients undergoing revascularization for critical limb ischemia. Material and Methods. A retrospective observational study of patients who underwent revascularization for critical limb ischemia in the University Hospital of Valladolid was designed. We classified patients into two groups according to the preoperative hemoglobin value, setting the cut-off point at 10 g / dL. Both groups were compared to estimate differences in major amputation, exitus, major amputation free survival, hospital stay and complications. Results. Of the 672 patients included in the study, 66 (9.9%) had a hemoglobin level below 10 g /dL. The group of anemic patients had higher 30-day (13.6% versus 5.4%) and one year (42.6% versus 14.7%) mortality; major amputation rate was also significantly worse after 30 days (21.2% vs. 8.3%) and a year (36.4% versus 20.7%). The major amputation-free survival was worse in anemic patients (68%, 62%, 56%, 50% and 47% versus 38%, 31%, 31%, 25% and 25% at 1, 2, 3, 4 and 5 years). Also, the average stay was higher in anemic patients (20.09 versus 14.96 19.38 +/-12.03 days). Conclusion. Preoperative anemia in patients who undergo revascularization for critical lower limb ischemia is associated with worse clinical outcome in terms of death and amputation, both short and long term as well as a higher rate of cardiorespiratory complications.