Abstract
ObjectiveTo evaluate the effect of preoperative anaemia and blood transfusion on 30-day postoperative morbidity and mortality in patients undergoing gynecological surgery.Study DesignData were analyzed from 12,836 women undergoing operation in the American College of Surgeons National Surgical Quality Improvement Program. Outcomes measured were; 30-day postoperative mortality, composite and specific morbidities (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thrombosis, or major bleeding). Multivariate logistic regression models were performed using adjusted odds ratios (ORadj) to assess the independent effects of preoperative anaemia (hematocrit <36.0%) on outcomes, effect estimates were performed before and after adjustment for perioperative transfusion requirement.ResultsThe prevalence of preoperative anaemia was 23.9% (95%CI: 23.2–24.7). Adjusted for confounders by multivariate logistic regression; preoperative anaemia was independently and significantly associated with increased odds of 30-day mortality (OR: 2.40, 95%CI: 1.06–5.44) and composite morbidity (OR: 1.80, 95%CI: 1.45–2.24). This was reflected by significantly higher adjusted odds of almost all specific morbidities including; respiratory, central nervous system, renal, wound, sepsis, and venous thrombosis. Blood Transfusion increased the effect of preoperative anaemia on outcomes (61% of the effect on mortality and 16% of the composite morbidity).ConclusionsPreoperative anaemia is associated with adverse post-operative outcomes in women undergoing gynecological surgery. This risk associated with preoperative anaemia did not appear to be corrected by use of perioperative transfusion.
Highlights
Preoperative anaemia is an emerging concern in patients undergoing surgery
Adjusted for confounders by multivariate logistic regression; preoperative anaemia was independently and significantly associated with increased odds of 30-day mortality (OR: 2.40, 95%CI: 1.06– 5.44) and composite morbidity (OR: 1.80, 95%CI: 1.45–2.24)
Blood Transfusion increased the effect of preoperative anaemia on outcomes (61% of the effect on mortality and 16% of the composite morbidity)
Summary
Preoperative anaemia is an emerging concern in patients undergoing surgery. This has been been attributed to the increased need for perioperative transfusions in the anaemic subject [1,2,3,4], which are independently associated with adverse postoperative outcomes even when as low as one unit of packed red blood cells (pRBC) is administered intraoperatively [5,6,7,8,9]. It has been established that preoperative anaemia carries an increased risk of longer hospital stay and increased postoperative morbidity and mortality, irrespective of the need for transfusion therapy [10,11,12,13,14,15,16,17,18]. The impact and effect of preoperative anaemia in a more homogenous and younger age group of patients undergoing surgery, less likely to have comorbidities’ is not known
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