Abstract
PurposeAnaemia is common in patients presenting with aneurysmal subarachnoid (aSAH) and intracerebral haemorrhage (ICH). In surgical patients, anaemia was identified as an idenpendent risk factor for postoperative mortality, prolonged hospital length of stay (LOS) and increased risk of red blood cell (RBC) transfusion. This multicentre cohort observation study describes the incidence and effects of preoperative anaemia in this critical patient collective for a 10-year period.MethodsThis multicentre observational study included adult in-hospital surgical patients diagnosed with aSAH or ICH of 21 German hospitals (discharged from 1 January 2010 to 30 September 2020). Descriptive, univariate and multivariate analyses were performed to investigate the incidence and association of preoperative anaemia with RBC transfusion, in-hospital mortality and postoperative complications in patients with aSAH and ICH.ResultsA total of n = 9081 patients were analysed (aSAH n = 5008; ICH n = 4073). Preoperative anaemia was present at 28.3% in aSAH and 40.9% in ICH. RBC transfusion rates were 29.9% in aSAH and 29.3% in ICH. Multivariate analysis revealed that preoperative anaemia is associated with a higher risk for RBC transfusion (OR = 3.25 in aSAH, OR = 4.16 in ICH, p < 0.001), for in-hospital mortality (OR = 1.48 in aSAH, OR = 1.53 in ICH, p < 0.001) and for several postoperative complications.ConclusionsPreoperative anaemia is associated with increased RBC transfusion rates, in-hospital mortality and postoperative complications in patients with aSAH and ICH.Trial registrationClinicalTrials.gov, NCT02147795, https://clinicaltrials.gov/ct2/show/NCT02147795
Highlights
Anaemia is an independent risk factor for postoperative complications, mortality, prolonged hospital length of stay (LOS) and increased risk of red blood cell (RBC) transfusion [24]
Preoperative anaemia was reported for 5.5% of patients suffering from aneurysmal subarachnoid haemorrhage [8] and for 24.1–25.8% of patients suffering from intracerebral haemorrhage (ICH) [16, 17]
Kumar et al demonstrated that anaemia is common in acute ICH patients and that its presence on admission is an independent predictor of increased ICH volume; contrary to pathophysiological considerations, in 2009, they could not demonstrate an effect on increased mortality [16]
Summary
Anaemia is an independent risk factor for postoperative complications, mortality, prolonged hospital length of stay (LOS) and increased risk of red blood cell (RBC) transfusion [24]. The prevalence of anaemia is reported to be 22.8% globally and 26.5-31.5% in patients undergoing surgery [2, 10]. For patients with ICH, anaemia has been shown to be an independent predictor for unfavourable long-term outcomes a decade ago [17]. RBC transfusions in patients undergoing cranial surgery are associated with a prolonged LOS, more postoperative complications, a 30-day return to the operating theatre and an increased 30-day mortality rate [4]. In patients with aSAH, RBC transfusions have been shown to result in increased mortality and general worse clinical outcomes [31]
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