Meta-analysis of the association between preoperative anaemia and mortality after surgery

Fowler, Alexander J.; Ahmad, Tahania; Phull, Mandeep; Allard, Shubha; Gillies, M. A.; Pearse, Rupert M

doi:10.1002/bjs.9861

Cited by 426 publications

(345 citation statements)

References 46 publications

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“…A meta-analysis including almost 950,000 noncardiac surgical procedures reported that preoperative anemia was linked to an increased risk of perioperative transfusion, morbidity (acute myocardial infarction, ischemic stroke, or kidney injury), and hospital and 30-day mortality [9]. In cardiac surgical procedures, preoperative anemia has also been shown to synergize with the negative effects of major blood loss and RBCT on mortality risk [10].…”

Section: Prevalence and Consequences Of Perioperative Anemiamentioning

confidence: 99%

Management of Perioperative Iron Deficiency Anemia

et al. 2019

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Preoperative anemia affects 30–40% of patients undergoing major surgery and is an independent risk factor for perioperative blood transfusion, morbidity, and mortality. Absolute or functional iron deficiency is its leading cause. Nonanemic hematinic deficiencies are also prevalent and may hamper preoperative hemoglobin optimization and/or recovery from postoperative anemia. As modifiable risk factors, anemia and hematinic deficiencies should be detected and corrected prior to major surgical procedures. Postoperative anemia is even more common (up to 80–90%) due to surgery-associated blood loss, inflammation-induced blunted erythropoiesis, and/or preexisting anemia. Preoperative oral iron may have a role in mild-to-moderate anemia, provided there is sufficient time (6–8 weeks) and adequate tolerance of oral preparations. Postoperative oral iron is of little value and rife with gastrointestinal adverse events. Intravenous iron should preferentially be used in cases of moderate-to-severe iron deficiency anemia, concomitant use of erythropoiesis-stimulating agents, short time to surgery or nonelective procedures, and for postoperative anemia management. Minor infusion reactions to intravenous iron are rare, the incidence of severe anaphylactic reactions is extremely low, and there is no increase in infections with intravenous iron. Currently available intravenous iron formulations allowing administration of large single doses are preferred.

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Section: Prevalence and Consequences Of Perioperative Anemiamentioning

confidence: 99%

Management of Perioperative Iron Deficiency Anemia

et al. 2019

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“…This correlation between anaemia and renal function is explained by the fact that both anaemia and renal disease are risk factors for ARF. 30 Moreover, LHTC patients were more likely to have lower systolic and mean arterial pressures, which are also risk factors for ARF.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Haematocrit and Outcome in Critically Ill Surgical Patients

et al. 2017

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Haematocrit has been studied as an outcome predictor. The aim of this study was to evaluate the correlation between low haematocrit at surgical intensive care unit admission and high disease scoring system score and early outcomes. Material and Methods: This retrospective study included 4398 patients admitted to the surgical intensive care unit between January 2006 and July 2013. Acute physiology and chronic health evaluation and simplified acute physiology score II values were calculated and all variables entered as parameters were evaluated independently. Patients were classified as haematocrit if they had a haematocrit < 30% at surgical intensive care unit admission. The correlation between admission haematocrit and outcome was evaluated by univariate analysis and linear regression.Results: A total of 1126 (25.6%) patients had haematocrit. These patients had higher rates of major cardiac events (4% vs 1.9%, p < 0.001), acute renal failure (11.5% vs 4.7%, p < 0.001), and mortality during surgical intensive care unit stay (3% vs 0.8%, p < 0.001) and hospital stay (12% vs 5.9%, p < 0.001). Discussion: A haematocrit level < 30% at surgical intensive care unit admission was frequent and appears to be a predictor for poorer outcome in critical surgical patients. Conclusion:Patients with haematocrit had longer surgical intensive care unit and hospital stay lengths, more postoperative complications, and higher surgical intensive care unit and hospital mortality rates.

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“…12 The aetiological reason for this is unclear, perhaps representing a surrogate marker for generalised ill health. Whether correction of preoperative anaemia improves postoperative mortality merits further investigation.…”

Section: Discussionmentioning

confidence: 99%

Patient and disease factors predictive of adverse perioperative outcomes after nephrectomy

Pitcher

Steenkamp

et al. 2016

annals

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INTRODUCTIONThe aim of this study was to determine the patient and disease factors predictive of adverse perioperative outcomes after nephrectomy using the British Association of Urological Surgeons (BAUS) audit database. METHODS All nephrectomies entered on the BAUS database for the year 2012 were included and ten patient or disease factors were selected for analysis. Logistic regression was used to calculate the area under the receiver operating characteristic curve (AUC) (0.5 = no better than chance, 1.0 = perfect prediction) for each variable and 500 bootstrap samples were used to determine variable selection. RESULTS Data were captured for 6,031 nephrectomies in 2012. World Health Organization performance status (WHO-PS) (AUC: 0.733) and anaemia (AUC: 0.696) were the most significant predictors of 30-day mortality in univariate analysis. WHO-PS (AUC: 0.626) and anaemia (AUC: 0.590) also predicted complications classified as Clavien-Dindo grades III-V. Anaemia (AUC: 0.722) and clinical T stage (AUC: 0.713) predicted need for transfusion. CONCLUSIONS Adverse perioperative outcomes after nephrectomy are predicted by clinical presentation with haematuria, poor WHO-PS and higher TNM (tumour, lymph nodes, metastasis) stage. This study used surgeon collected data as opposed to an administrative database, which may have advantages in terms of accuracy and breadth of data fields. These data form a basis for preoperative patient counselling and informed consent for nephrectomy. They can also be used as a standard against which surgeons and hospitals can compare their own results.

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Meta-analysis of the association between preoperative anaemia and mortality after surgery

Cited by 426 publications

References 46 publications

Management of Perioperative Iron Deficiency Anemia

Management of Perioperative Iron Deficiency Anemia

Postoperative Haematocrit and Outcome in Critically Ill Surgical Patients

Patient and disease factors predictive of adverse perioperative outcomes after nephrectomy

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