Preoperative anaemia and clinical outcomes in the South African Surgical Outcomes Study

Abstract

In high-income countries, preoperative anaemia has been associated with increased postoperative morbidity and mortality. [1] Preoperative anaemia is a common problem, with three large database studies in Europe and America estimating the prevalence to be between 25% and 30%. [2-4] Anaemia is also associated with increased perioperative blood transfusions, a practice independently associated with morbidity and mortality. [5] Growing evidence supports increasingly restrictive transfusion strategies in surgical and critical care patients, and as a result allogeneic transfusions can no longer be considered an appropriate isolated management strategy for surgical patients with preoperative anaemia. [6,7] Furthermore, the demographics of the South African (SA) surgical population differ significantly from those of the populations in which the morbidity associated with preoperative anaemia has been described. SA non-cardiac surgical patients are younger, have fewer non-communicable diseases, and undergo significantly more urgent and emergency This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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“…In South Africa, perioperative anaemia is associated with a greater need for critical care services and increased complications. 6 Jadhunandan et al found a high prevalence of perioperative anaemia in this group of high-risk general surgical patients. Importantly, moderate to severe perioperative anaemia is associated with an increased postoperative mortality.…”

“…The prevalence was higher than that found in the South African Surgical Outcomes Study (SASOS). 6 There are several reasons for this observation, although they are mostly related to the study population of Jadhunandan et al, 2 which included more patients with cancer and chronic medical conditions which adversely affect red blood cell production. 2,6 Improving oxygen delivery is a proposed mechanism for potentially reducing postoperative morbidity and mortality.…”

Surgery as a component of universal healthcare: Where is South Africa?

“…Since then, perioperative research has been conducted in SA to quantify the LCoGS indicators and identify health system gaps in workforce, [13,14] infrastructure [15][16][17] and quality. [18][19][20] While more than 96% of South Africans live within 2 hours of a government hospital, [21] quality surgical care is variable and lags behind global standards. [20] Governance, financing, service delivery, infrastructure, the workforce and data systems must be optimised to improve surgical outcomes at a national level.…”

Preoperative anaemia in patients undergoing open intra-abdominal surgery at a South African tertiary hospital

“…8 The association between PA and a higher risk of postoperative critical care admission was confirmed by Marsicano and colleagues in a sub-analysis of data from the South African Surgical Outcomes Study (SASOS). 9 The authors found that SASOS patients with PA were at a 49% higher risk of requiring critical care services postoperatively when compared with non-anaemic patients. 9 Patients with PA also have a higher risk of postoperative mortality (PM) when compared with nonanaemic patients.…”

“…4 Most of these prevalence estimates, ranging between 28.7% and 47.8%, are based on observations in mixed surgical populations. [7][8][9][10] Another important finding from studies investigating PA in mixed surgical populations is the association of this condition with an increased risk of postoperative complications. [7][8][9][10] A study by Musallam et al of 227 425 non-cardiac surgery patients (of which 30.4% had PA)…”