Prevalence of pre‐operative anaemia in surgical patients: a retrospective, observational, multicentre study in Germany

Judd, Leonie; Hof, Lotta; Beladdale, L.; Friederich, Patrick; Thoma, J.; Wittmann, Maria; Zacharowski, Kai; Meybohm, Patrick; Choorapoikayil, Suma

doi:10.1111/anae.15847

Cited by 9 publications

(8 citation statements)

References 30 publications

(44 reference statements)

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“…[48] However, other studies have not found a signi cant association between blood transfusions and survival outcomes in patients with gastric cancer or hospital LOS. [49,50] Given these risks, it is recommended that blood transfusions are to be used judiciously and alternative strategies such as erythropoietin-stimulating agents and iron supplementation, should be considered to reduce the need for blood transfusions in the perioperative period. [51][52][53][54] Prolonged LOS is associated with preoperative, intraoperative and post-operative factors.…”

Section: Discussionmentioning

confidence: 99%

Post-operative Anaemia Independently Predicts Prolonged Hospital Length of Stay After Upper Gastrointestinal Cancer Surgery

Ng,

Jones,

Mitteregger

et al. 2024

Preprint

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Background Prolonged hospital length of stay (LOS) after major surgery is associated with increased mortality rates, readmissions, and postoperative complications, adversely affecting functional recovery. To address this issue and optimize resource allocation, we conducted a retrospective cohort study focusing on elective upper gastrointestinal cancer surgeries. Methods Observational retrospective cohort study of all patients who underwent various upper gastrointestinal cancer procedures at a major tertiary hospital in 2021. Data were extracted from a prospective database. Pre-, intra-, and post-operative factors were collected. Patients were dichotomized into expected LOS and prolonged LOS. Results 111 patients were analyzed. The average age was 64.0 years and 36.9% underwent a Whipple’s procedure. 23.4% of the patients had prolonged hospital LOS. Patients with longer hospital LOS had no neoadjuvant radiation therapy (84.6% vs 82.4%, p = 0.016), more readmission to the theatre (34.6% vs 7.1%, p = 0.001), more unplanned ICU admissions (15.4% vs 2.4%, p = 0.023), longer ICU admissions (76.9% vs 74.1%, p = 0.012), lower intra-op Hb (106.5 ± 17.9 vs 115.8 ± 17.0, p = 0.021), lower day 1 post-op Hb (100.1 ± 17.3 vs 111.7 ± 15.7, p = 0.002), lower 1st -week nadir Hb (89.3 ± 17.0 vs 104.9 ± 16.6, p < 0.001) and more post-op transfusion requirements (23.1% vs 5.9%, p = 0.019). Univariate analysis identified several significant predictors of prolonged hospital LOS, including unplanned ICU admission, readmission to theatre, lowest intra-op Hb, lowest day 1 post-op Hb and 1st week Hb nadir. Multivariate analysis adjusting for unplanned ICU admission (OR = 6.80, CI 1.03-45.00, p = 0.047) and readmission to theatre (OR 8.48, CI 2.40–30.00, p = 0.001) revealed that lower Hb levels (OR 0.95, CI 0.92–0.98, p = 0.002) were associated with prolonged hospital LOS. Conclusion Post-operative anemia, unplanned return to theatre and unplanned ICU admission are significant factors contributing to extended hospital stays. Addressing post-operative anemia may effectively reduce hospital LOS.

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Section: Discussionmentioning

confidence: 99%

Post-operative Anaemia Independently Predicts Prolonged Hospital Length of Stay After Upper Gastrointestinal Cancer Surgery

Ng,

Jones,

Mitteregger

et al. 2024

Preprint

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“…32 However, studies have shown that transfusion did not reverse the harms of perioperative anemia in elderly hip fracture patients, and it is associated with poor outcomes such as subsequent infection, fluid overload, prolonged hospital stays, and increased mortality. [33][34][35] Given the shortage of blood supply, restrictive transfusion (70-90 g/L) may be a viable alternative that can reduce transfusion rates by 39-43% compared to unrestricted transfusion (90-110 g/L) and does not increase risk of complications such as myocardial infarction or mortality. 35,36 Therefore, the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines recommend a transfusion threshold of no higher than 80 g/L in patients with hip fractures.…”

Section: Clinical Implicationmentioning

confidence: 99%

Preoperative Anemia and Risk of In-hospital Postoperative Complications in Patients with Hip Fracture

Yu¹,

Lin²,

Wang³

et al. 2023

CIA

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Purpose To evaluate the impact of preoperative anemia on postoperative complications after hip fracture surgery. Patients and Methods We conducted a retrospective study including hip fracture patients at a teaching hospital between 2005 and 2022. We defined preoperative anemia as the last hemoglobin measurement level before surgery < 130 g/L for men and < 120 g/L for women. The primary outcome was a composite of in-hospital major complications, including pneumonia, respiratory failure, gastrointestinal bleeding, urinary tract infection, incision infection, deep venous thrombosis, pulmonary embolism, angina pectoris, arrhythmia, myocardial infarction, heart failure, stroke, and death. Secondary outcomes were cardiovascular events, infection, pneumonia, and death. We used multivariate negative binomial or logistic regression to evaluate the impact of anemia and its severity, categorized as mild (90–130 g/L for men, 90–120 g/L for women) or moderate-to-severe (< 90 g/L for both) anemia on outcomes. Results Of the 3540 included patients, 1960 had preoperative anemia. 188 anemic patients experienced 324 major complications, while 63 non-anemic patients had 94 major complications. The risk of major complications was 165.3 (95% CI, 149.5–182.4) and 59.5 (95% CI, 48.9–72.3) per 1000 persons in anemic and non-anemic patients, respectively. Anemic patients were more likely to have major complications than non-anemic patients (adjusted incidence rate ratio (aIRR), 1.87; 95% CI, 1.30–2.72), which was consistent in mild (aIRR, 1.77; 95% CI, 1.22–2.59) and moderate-to-severe (aIRR, 2.97; 95% CI, 1.65–5.38) anemia. Preoperative anemia also increased the risk of cardiovascular events (aIRR, 1.96; 95% CI, 1.29–3.01), infection (aIRR, 1.68; 95% CI, 1.01–2.86), pneumonia (adjusted odds ratio (aOR), 1.91; 95% CI, 1.06–3.57), and death (aOR, 3.17; 95% CI, 1.06–11.89). Conclusion Our findings suggest that even mild preoperative anemia is associated with major postoperative complications in hip fracture patients. This finding highlights considering preoperative anemia as a risk factor in surgical decision-making for high-risk patients.

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“…Iron deficiency (ID) is still the top-ranking cause of anemia in the general population worldwide [ 2 ]. In preoperative patients, the prevalence of ID ranges from 23 to 33% [ 3 , 4 ], with a wide variation between surgical fields (e.g., gynecology (59%), plastic surgery (11%)) [ 4 ]. Preoperative anemia is associated with an increased risk of allogeneic blood transfusions, length of hospital stay, morbidity, and mortality [ 4 , 5 ] making ID an important target to diagnose and treat before elective surgery [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Reported outcomes in patients with iron deficiency or iron deficiency anemia undergoing major surgery: a systematic review of outcomes

Stangl,

Popp,

Reis

et al. 2024

Syst Rev

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Background Iron deficiency (ID) is the leading cause of anemia worldwide. The prevalence of preoperative ID ranges from 23 to 33%. Preoperative anemia is associated with worse outcomes, making it important to diagnose and treat ID before elective surgery. Several studies indicated the effectiveness of intravenous iron supplementation in iron deficiency with or without anemia (ID(A)). However, it remains challenging to establish reliable evidence due to heterogeneity in utilized study outcomes. The development of a core outcome set (COS) can help to reduce this heterogeneity by proposing a minimal set of meaningful and standardized outcomes. The aim of our systematic review was to identify and assess outcomes reported in randomized controlled trials (RCTs) and observational studies investigating iron supplementation in iron-deficient patients with or without anemia. Methods We searched MEDLINE, CENTRAL, and ClinicalTrials.gov systematically from 2000 to April 1, 2022. RCTs and observational studies investigating iron supplementation in patients with a preoperative diagnosis of ID(A), were included. Study characteristics and reported outcomes were extracted. Outcomes were categorized according to an established outcome taxonomy. Quality of outcome reporting was assessed with a pre-specified tool. Reported clinically relevant differences for sample size calculation were extracted. Results Out of 2898 records, 346 underwent full-text screening and 13 studies (five RCTs, eight observational studies) with sufficient diagnostic inclusion criteria for iron deficiency with or without anemia (ID(A)) were eligible. It is noteworthy to mention that 49 studies were excluded due to no confirmed diagnosis of ID(A). Overall, 111 outcomes were structured into five core areas including nine domains. Most studies (92%) reported outcomes within the ‘blood and lymphatic system’ domain, followed by “adverse event” (77%) and “need for further resources” (77%). All of the latter reported on the need for blood transfusion. Reported outcomes were heterogeneous in measures and timing. Merely, two (33%) of six prospective studies were registered prospectively of which one (17%) showed no signs of selective outcome reporting. Conclusion This systematic review comprehensively depicts the heterogeneity of reported outcomes in studies investigating iron supplementation in ID(A) patients regarding exact definitions and timing. Our analysis provides a systematic base for consenting to a minimal COS. Systematic review registration PROSPERO CRD42020214247

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Prevalence of pre‐operative anaemia in surgical patients: a retrospective, observational, multicentre study in Germany

Cited by 9 publications

References 30 publications

Post-operative Anaemia Independently Predicts Prolonged Hospital Length of Stay After Upper Gastrointestinal Cancer Surgery

Post-operative Anaemia Independently Predicts Prolonged Hospital Length of Stay After Upper Gastrointestinal Cancer Surgery

Preoperative Anemia and Risk of In-hospital Postoperative Complications in Patients with Hip Fracture

Reported outcomes in patients with iron deficiency or iron deficiency anemia undergoing major surgery: a systematic review of outcomes

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