Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study

Musallam, Khaled M.; Tamim, Hani; Richards, Toby; Spahn, Donat R.; Rosendaal, Frits R.; Habbal, A.; Khreiss, Mohammad; Dahdaleh, Fadi S.; Khavandi, Kaivan; Sfeir, Pierre; Soweid, Assaad; Hoballah, Jamal J.; Taher, Ali T.; Jamali, Faek R.

doi:10.1016/s0140-6736(11)61381-0

Cited by 1,004 publications

(789 citation statements)

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“…This study evaluated Ͼ227 000 patients who underwent major noncardiac surgery and found that even mild anemia (hematocrit 29%-39%) was independently associated with an increase in 30-day morbidity and mortality. 7 An important caution is that, in all of these studies, it is unclear whether anemia is just a marker for sicker patients or is itself responsible for increased mortality.…”

Section: Risks From Anemiamentioning

confidence: 99%

Transfusion strategies in hematologic and nonhematologic disease

Carson

Strair

2014

Hematology

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Substantial progress has been made in our understanding of the risks and benefits of RBC transfusion through the performance of large clinical trials. More than 7000 patients have been enrolled in trials randomly allocating patients to higher transfusion thresholds (ϳ9-10 g/dL), referred to as liberal transfusion, or lower transfusion thresholds (ϳ7-8 g/dL), referred to as restrictive transfusion. The results of most of the trials suggest that a restrictive transfusion strategy is safe and, in some cases, superior to a liberal transfusion strategy. However, in patients with myocardial infarction, brain injury, stroke, or hematological disorders, more large trials are needed because preliminary evidence suggests that liberal transfusion might be beneficial or trials have not been performed at all. Learning Objective• To understand the clinical trial evidence that has evaluated the effect of blood transfusion on mortality and morbidity

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Section: Risks From Anemiamentioning

confidence: 99%

Transfusion strategies in hematologic and nonhematologic disease

Carson

Strair

2014

Hematology

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“…[1][2][3] The recent finding that mild and moderate cases of anemia are also associated with increased mortality in patients undergoing cardiac and non-cardiac surgery makes this a critically important area of anesthesia research. 4,5 Experimental studies have shown that both hypoxic and nonhypoxic mechanisms may contribute to anemia-induced organ injury and mortality. 3,6,7 The complex nature of the cellular mechanisms involved may explain why anemiainduced mortality is not necessarily improved by therapies which increase blood oxygen content, including red blood cell (RBC) transfusions, 8,9 use of erythropoiesis stimulating agents (ESAs), 10 or hemoglobin-based oxygen carriers (HBOCs).…”

Section: Résumémentioning

confidence: 99%

Plasma methemoglobin as a potential biomarker of anemic stress in humans

Hare

Romaschin

et al. 2012

Can J Anesth/J Can Anesth

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Purpose Transfusion of allogeneic red blood cells (RBCs) is one of the main treatments of acute anemia secondary to blood loss and fluid resuscitation within the operating room. Decisions to transfuse blood are based largely on intermediate biological markers (hemoglobin, arterial oxygen saturation, blood pressure, heart rate) which may not accurately reflect inadequacy of tissue oxygen delivery.Based on experimental studies, we hypothesized that anemia-induced tissue hypoxia activates adaptive mechanisms which promote local vascular nitric oxide (NO) production to improve tissue perfusion and survival during acute anemia. Hemoglobin (Hb) oxidation to methemoglobin (MetHb) may be a byproduct of such local NO production. Therefore, we tested the hypothesis that MetHb is a biomarker of hypoxic-anemic stress during acute hemodilution associated with cardiopulmonary bypass. Methods With institutional ethics approval, routine laboratory arterial blood gas and co-oximetry values were obtained from 295 patients undergoing heart surgery during February 1 to September 30, 2010, and the values were assessed retrospectively. All samples with an arterial oxygen saturation value C90% were included (n = 1,421). The maximal change in Hb associated with hemodilution on cardiopulmonary bypass was determined within 48 hr of surgery (n = 180). A chart review was performed to determine the incidence of RBC transfusion and exogenous nitrate administration. All anonymous data were analyzed by linear regression to determine the relationship between Author contributions Gregory M.T. Hare designed the research, performed the research, contributed novel intellectual input, analyzed the data, and wrote the paper. Alexander Mu performed the research, contributed novel intellectual input, and analyzed the data. Alexander Romaschin designed the research, performed the research, contributed novel intellectual input, and analyzed the data. Nadine Shehata designed the research, performed the research, contributed novel intellectual input, and analyzed the data. W. Scott Beattie designed the research, performed the research, contributed novel intellectual input, analyzed the data, and wrote the paper. C. David Mazer designed the research, performed the research, contributed novel intellectual input, analyzed the data, and wrote the paper. Albert K.Y. Tsui contributed novel intellectual input, analyzed the data, and wrote the paper. RésuméObjectif La transfusion de globules rouges alloge´niques est l'un des principaux traitements de l'ane´mie aigues econdaire a`une perte sanguine et au remplissage liquidien en salle d'ope´ration. La de´cision de transfuser du sang repose essentiellement sur des marqueurs biologiques interme´diaires (he´moglobine, saturation en oxyge`ne du sang arte´riel, pression arte´rielle, fre´quence cardiaque) qui pourraient ne pas refle´ter avec pre´cision l'insuffisance d'apport d'oxyge`ne aux tissus. A`partir d'e´tudes expe´rimentales nous avons fait l'hypothe`se qu'une hypoxie tissulaire induite par l'ane´mie act...

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“…11 12 A recent retrospective cohort study demonstrated a higher postoperative 30 day morbidity and mortality in patients who underwent major non-cardiac surgery with preoperative anaemia than in those without anaemia. 13 In elderly patients with hip fracture, anaemia (Hb ,12 g dl 21 for females and ,13 g dl 21 for males) was significantly associated with 2-to 5-and 3-fold increases in the multivariate-adjusted risk of 6 and 12 month mortality, respectively. 14 Patients with Hb ,10 g dl 21 were at a 5-fold increased risk of death.…”

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confidence: 95%