Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study
Editorial: Lancet
Fecha: 01/11/2011
Khaled M Musallam, Hani M Tamim, Toby Richards, Donat R Spahn, Frits R Rosendaal, Aida Habbal, Mohammad Khreiss, Fadi S Dahdaleh,Kaivan Khavandi , Pierre M Sfeir, Assaad Soweid, Jamal J Hoballah, Ali T Taher, Faek R Jamali
Summary
Background Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after
non-cardiac surgery are not well established. We aimed to assess the eff ect of preoperative anaemia on 30-day
postoperative morbidity and mortality in patients undergoing major non-cardiac surgery.
Methods We analysed data for patients undergoing major non-cardiac surgery in 2008 from The American College of
Surgeons¡¯ National Surgical Quality Improvement Program database (a prospective validated outcomes registry from
211 hospitals worldwide in 2008). We obtained anonymised data for 30-day mortality and morbidity (cardiac,
respiratory, CNS, urinary tract, wound, sepsis, and venous thromboembolism outcomes), demographics, and
preoperative and perioperative risk factors. We used multivariate logistic regression to assess the adjusted and
modifi ed (nine predefi ned risk factor subgroups) eff ect of anaemia, which was defi ned as mild (haematocrit
concentration >29¨C<39% in men and >29¨C<36% in women) or moderate-to-severe (¡Ü29% in men and women) on postoperative outcomes. Findings We obtained data for 227 425 patients, of whom 69 229 (30¡¤44%) had preoperative anaemia. After adjustment, postoperative mortality at 30 days was higher in patients with anaemia than in those without anaemia (odds ratio [OR] 1¡¤42, 95% CI 1¡¤31¨C1¡¤54); this diff erence was consistent in mild anaemia (1¡¤41, 1¡¤30¨C1¡¤53) and moderate-to-severe anaemia (1¡¤44, 1¡¤29¨C1¡¤60). Composite postoperative morbidity at 30 days was also higher in patients with anaemia than in those without anaemia (adjusted OR 1¡¤35, 1¡¤30¨C1¡¤40), again consistent in patients with mild anaemia (1¡¤31, 1¡¤26¨C1¡¤36) and moderate-to-severe anaemia (1¡¤56, 1¡¤47¨C1¡¤66). When compared with patients without anaemia or a defi ned risk factor, patients with anaemia and most risk factors had a higher adjusted OR for 30-day mortality and morbidity than did patients with either anaemia or the risk factor alone. Interpretation Preoperative anaemia, even to a mild degree, is independently associated with an increased risk of 30-day morbidity and mortality in patients undergoing major non-cardiac surgery.
Background Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after
non-cardiac surgery are not well established. We aimed to assess the eff ect of preoperative anaemia on 30-day
postoperative morbidity and mortality in patients undergoing major non-cardiac surgery.
Methods We analysed data for patients undergoing major non-cardiac surgery in 2008 from The American College of
Surgeons¡¯ National Surgical Quality Improvement Program database (a prospective validated outcomes registry from
211 hospitals worldwide in 2008). We obtained anonymised data for 30-day mortality and morbidity (cardiac,
respiratory, CNS, urinary tract, wound, sepsis, and venous thromboembolism outcomes), demographics, and
preoperative and perioperative risk factors. We used multivariate logistic regression to assess the adjusted and
modifi ed (nine predefi ned risk factor subgroups) eff ect of anaemia, which was defi ned as mild (haematocrit
concentration >29¨C<39% in men and >29¨C<36% in women) or moderate-to-severe (¡Ü29% in men and women) on postoperative outcomes. Findings We obtained data for 227 425 patients, of whom 69 229 (30¡¤44%) had preoperative anaemia. After adjustment, postoperative mortality at 30 days was higher in patients with anaemia than in those without anaemia (odds ratio [OR] 1¡¤42, 95% CI 1¡¤31¨C1¡¤54); this diff erence was consistent in mild anaemia (1¡¤41, 1¡¤30¨C1¡¤53) and moderate-to-severe anaemia (1¡¤44, 1¡¤29¨C1¡¤60). Composite postoperative morbidity at 30 days was also higher in patients with anaemia than in those without anaemia (adjusted OR 1¡¤35, 1¡¤30¨C1¡¤40), again consistent in patients with mild anaemia (1¡¤31, 1¡¤26¨C1¡¤36) and moderate-to-severe anaemia (1¡¤56, 1¡¤47¨C1¡¤66). When compared with patients without anaemia or a defi ned risk factor, patients with anaemia and most risk factors had a higher adjusted OR for 30-day mortality and morbidity than did patients with either anaemia or the risk factor alone. Interpretation Preoperative anaemia, even to a mild degree, is independently associated with an increased risk of 30-day morbidity and mortality in patients undergoing major non-cardiac surgery.