Preoperative Red Cell Distribution Width and 30-day mortality in older patients undergoing non-cardiac surgery: a retrospective cohort observational study

H R Abdullah,B C Ong,Y T Sim,A L Ang,T Richards,Y E Sim,Y H Chan

doi:10.1038/s41598-018-24556-z

H R Abdullah, B C Ong + Show 5 more

Open Access

https://doi.org/10.1038/s41598-018-24556-z

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Journal: Scientific Reports	Publication Date: Apr 18, 2018
Citations: 26	License type: open-access

Affiliation: University College London

Abstract

Increased red cell distribution width (RDW) is associated with poorer outcomes in various patient populations. We investigated the association between preoperative RDW and anaemia on 30-day postoperative mortality among elderly patients undergoing non-cardiac surgery. Medical records of 24,579 patients aged 65 and older who underwent surgery under anaesthesia between 1 January 2012 and 31 October 2016 were retrospectively analysed. Patients who died within 30 days had higher median RDW (15.0%) than those who were alive (13.4%). Based on multivariate logistic regression, in our cohort of elderly patients undergoing non-cardiac surgery, moderate/severe preoperative anaemia (aOR 1.61, p = 0.04) and high preoperative RDW levels in the 3rd quartile (>13.4% and ≤14.3%) and 4th quartile (>14.3%) were significantly associated with increased odds of 30-day mortality - (aOR 2.12, p = 0.02) and (aOR 2.85, p = 0.001) respectively, after adjusting for the effects of transfusion, surgical severity, priority of surgery, and comorbidities. Patients with high RDW, defined as >15.7% (90th centile), and preoperative anaemia have higher odds of 30-day mortality compared to patients with anaemia and normal RDW. Thus, preoperative RDW independently increases risk of 30-day postoperative mortality, and future risk stratification strategies should include RDW as a factor.

Highlights

Red cell distribution width (RDW) is an automated measure of the heterogeneity in erythrocyte sizes and is routinely performed as part of a Full Blood Count[1,2]
We aim to investigate the association between preoperative red cell distribution width (RDW) and 30-day mortality among the elderly patients undergoing non-cardiac surgery and hypothesize that there is a significant association between increased RDW and 30-day mortality
As anisocytosis is closely related to the presence of anaemia, we aim to explore the impact of anaemia on the relationship between RDW and 30-day postoperative mortality

Summary

Introduction

Red cell distribution width (RDW) is an automated measure of the heterogeneity in erythrocyte sizes and is routinely performed as part of a Full Blood Count[1,2]. An increase in RDW, termed anisocytosis, reflects increased variation in the sizes of red blood cells (RBC) attributable to the presence of small and large RBCs, or both. Its association with shorter term outcomes such as 30-day mortality remains to be elucidated. There is a need to identify significant perioperative risk factors that allow accurate risk stratification for short term outcomes such as mortality and morbidity. This could facilitate meaningful informed patient consent and shared decision-making as well as facilitate targeted perioperative risk mitigation strategies[24,25]. As anisocytosis is closely related to the presence of anaemia, we aim to explore the impact of anaemia on the relationship between RDW and 30-day postoperative mortality

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