Association of preoperative anaemia with postoperative morbidity and mortality: an observational cohort study in low-, middle-, and high-income countries

Fowler, Alexander J.; Ahmad, Tahania; Abbott, Tom; Torrance, Hew D.T.; Wouters, Patrick; Hert, Stefan De; Lobo, Suzana Margareth; Rasmussen, Lars S.; Rocca, Giorgio Della; Beattie, W. Scott; Wijeysundera, Duminda N.; Pearse, Rupert M

doi:10.1016/j.bja.2018.08.026

Cited by 57 publications

(61 citation statements)

References 44 publications

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“…Anaemia was diagnosed in 43% of patients in the group who developed postoperative delirium, and only 19% in the group without delirium. Previous studies have shown that preoperative anaemia was considered a risk factor for the outcome in non-cardiac surgery; it was associated with a more extended hospital stay, a higher risk of perioperative complications, and higher mortality [35]. In a recent study of 800 patients undergoing elective noncardiac surgery, anaemia was associated with postoperative delirium and longer hospitalization [36].…”

Section: Discussionmentioning

confidence: 99%

Elevated Procalcitonin and Depression As Risk Factors For Postoperative Delirium In The Elderly After Cardiac Surgery – A Prospective Observational Study.

Kupiec

Adamik

Kozera

et al. 2020

Preprint

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Background One of the most common complications after cardiac surgery is delirium. Determining the origin of this complication from possible pathomechanisms is difficult. The activation of an inflammatory response during surgery has been suggested as one possible mechanism of delirium. The usefulness of the inflammatory marker procalcitonin (PCT) as a predictor of delirium after cardiac surgery with cardiopulmonary bypass (CBP) has not yet been investigated. Methods The purpose of this study was to prospectively investigate the risk of developing postoperative delirium in a group of elderly patients using a multivariate assessment of preoperative (PCT, comorbidities, functional decline, depression) and intraoperative risk factors. 149 elderly patients were included. Delirium was assessed using the Confusion Assessment Method for the ICU. Results Thirty patients (20%) developed post-operative delirium: hypoactive in 50%, hyperactive in 33%, mixed in 17%. Preoperative PCT above the reference range (> 0.05 ng/mL) was recorded more often in patients who postoperatively developed delirium than in the non-delirium group (50% vs. 27%, p=0.019). After surgery, PCT was significantly higher in the delirium than the non-delirium group: ICU admission after surgery: 0.08 ng/mL, IQR 0.03-0.15 vs. 0.05 ng/mL, IQR 0.02-0.09, p=0.011), and for consecutive days (day 1: 0.59 ng/mL, IQR 0.25-1.55 vs. 0.25 ng/mL, IQR 0.14-0.54, p=0.003; day 2: 1.21 ng/mL, IQR 0.24-3.29 vs. 0.36 ng/mL, IQR 0.16-0.76, p=0.006; day 3: 0.76 ng/mL, IQR 0.48-2.34 vs. 0.34 ng/mL, IQR 0.14-0.66, p=0.001). Patients with delirium were older (74 years, IQR 70 – 76 vs. 69 years, IQR 67 – 74; p=0.038) and more often had functional decline (47% vs. 28%, p=0.041). There was no difference in comorbidities with the exception of anaemia (43% vs. 19%, p=0.006). Depression was detected in 40% of patients with delirium and in 17% without delirium (p=0.005). In a multivariable logistic regression model of preoperative procalcitonin (OR= 3.05; IQR 1.02-9.19), depression (OR=5.02, IQR 1.67-15.10), age (OR=1.14; IQR 1.02-1.26), functional decline (OR=0.76; IQR 0.63-0.91) along with CPB time (OR=1.04; IQR 1.02-1.06) were significant predictors of postoperative delirium. Conclusion A preoperative PCT test and assessment of functional decline and depression may help identify patients at risk for developing delirium after cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Elevated Procalcitonin and Depression As Risk Factors For Postoperative Delirium In The Elderly After Cardiac Surgery – A Prospective Observational Study.

Kupiec

Adamik

Kozera

et al. 2020

Preprint

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“…ERAS emphasises early assessment and optimisation of chronic illness. Patients should have haemoglobin concentration measured before major elective surgery, and patients who are anaemic should be treated appropriately as preoperative anaemia is associated with postoperative morbidity and mortality 13 . Lower preoperative haemoglobin level is associated with longer hospital stay and a higher rate of allogeneic blood transfusion, which is associated with an increased risk of adverse effects 14 .…”

Section: Preoperative Assessment and Optimisationmentioning

confidence: 99%

Enhanced recovery for gynaecological surgery: a review

Yim

Lam

2019

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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We review various aspects of enhanced recovery after surgery for gynaecological patients, including patient education and counselling, preoperative assessment and optimisation, preoperative fasting and nutrition, bowel preparation, thromboembolism prophylaxis, perioperative analgesia, peritoneal drains and urinary catheters, postoperative nausea and vomiting, hypothermia prevention, early feeding and early mobilisation, and implementation of enhanced recovery after surgery.

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“…2 This may inform the optimal treatment of the surprisingly large proportion of patients (approximately 30%) who are anemic prior to undergoing elective surgery. 3 Many of these patients are iron deficient, and therefore may benefit from iron alone. In this setting, the endogenous EPO ''builder'' will be given adequate ''building blocks'' for erythropoiesis.…”

Section: To the Editormentioning

confidence: 99%