ORIGINAL CONTRIBUTION Preoperative Hematocrit Levels and Postoperative Outcomes in Older Patients Undergoing Noncardiac Surgery

ELDERLY PATIENTS ARE AT IN-creased riskof both abnormalhe-matocrit values and cardiovas-cular complicat ions of noncardiac surgery.1,2Despitenearlyuni-versal measurement of hematocrit val-ues prior to major surgery,3 the prog-nostic implications of preoperative anemia or polycythemia are incom-pletely understood for this high-risk population. Although we have previ-ously found that even mild degrees of anemia increase themortality risk of el-derly patientswith acutemyocardial in-farction,4 surgical studies of mild ane-mia have not shown it to be a risk factor for death, unless cardiac disease is pres-ent or major blood loss occurs.5-7 The limited physiologic reserve and the higher prevalence of unrecognized car-diovascular disease may still render the elderly population vulnerable tomilder degrees of anemiawhenundergoing the stress of surgery.8-10 For editorial comment see p 2525.