• Marcus Taylor, Udo Abah, Tim Hayes, Thomas Eadington, Matthew Smith, Michael Shackcloth, Felice Granato, Rajesh Shah, Richard Booton, Stuart W Grant, and North West Thoracic Surgery Collaborative (NWTSC).
• Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom. Electronic address: Marcus.taylor1@nhs.net.
• J. Cardiothorac. Vasc. Anesth. 2022 May 1; 36 (5): 1373-1379.

ObjectivesAlthough some evidence to suggest an association between preoperative anemia and reduced overall survival exists, contemporary studies investigating the impact of preoperative anemia on outcomes after resection for primary lung cancer are lacking.DesignA multicenter retrospective review.SettingTwo tertiary cardiothoracic surgery centers in the Northwest of England.ParticipantsA total of 5,029 patients between 2012 and 2018.InterventionsAll patients underwent lung resection for primary lung cancer. Patients were classified as anemic based on the World Health Organization definition. Men with hemoglobin <130 g/L and women with hemoglobin <120 g/L were considered to be anemic.Measurements And Main ResultsOutcomes assessed included perioperative mortality, 90-day mortality, and overall survival. Multivariate logistic and Cox regression analyses were used to assess the impact of preoperative anemia on 90-day mortality and overall survival, respectively. Overall, preoperatively, 24.0% (n = 1207) of patients were anemic. The 90-day mortality for anemic and nonanemic patients was 5.6% and 3.1%, respectively (p < 0.001). After multivariate adjustment, preoperative anemia was not associated with increased 90-day mortality. However, a log-rank analysis demonstrated reduced overall survival for anemic patients (p < 0.001). After multivariate adjustment, preoperative anemia was found to be independently associated with reduced overall survival (hazard ratio 1.287, 95% confidence interval 1.141-1.451, p < 0.001).ConclusionsAlthough anemia was not an independent predictor of short-term outcomes, it was independently associated with significantly reduced survival for patients undergoing resection for lung cancer. Further work is required to understand why anemia reduces long-term survival and whether pathways for anemic patients can be adapted to improve long-term outcomes.Copyright © 2021 Elsevier Inc. All rights reserved.

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