The Association of Preoperative Hematocrit and Transfusion with Mortality in Patients Undergoing Elective Non‐cardiac Surgery

Gabriel, Rodney A.; Clark, Anthony; Nguyen, Albert; Waterman, Ruth S.; Schmidt, Ulrich

doi:10.1007/s00268-017-4359-y

Cited by 24 publications

(19 citation statements)

References 24 publications

(31 reference statements)

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“…Stratification of the matched cohort by preoperative hematocrit revealed significantly increased risk of bleeding with decreasing levels of hematocrit (Table ). These findings are congruent with those published by Gabriel et al, a study that examined preoperative hematocrit in noncardiac surgery …”

Section: Discussionsupporting

confidence: 93%

Anemia and blood transfusion requirements in endoscopic sinus surgery: A propensity‐matched analysis

et al. 2019

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Objective: Massive bleeding requiring blood transfusion is a feared complication of endoscopic sinus surgery (ESS). In an effort to improve healthcare quality and outcomes, research is focused on identifying the risk factors for complications following surgical procedures. Blood transfusions have been linked to increased complication rates, but their role has not been extensively studied in ESS.Methods: The American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) participant user files 2005 to 2014 were queried for all cases of ESS. Patients were divided into cohorts based on anemia (hematocrit <39.00 in men and <36.00 in women) and hematocrit levels. Univariate analyses and a propensity score-matching algorithm were employed.Results: Of 630 cases of ESS, 117 (18.6%) had preexisting anemia. Anemic patients were more likely to be black (19.8% vs. 6.7%, P ≤ 0.001), undergo longer operation times (117.50 minutes AE155.73 vs. 129.85 minutes AE36.03, P = 0.005), have diabetes (28.2% vs. 10.9%, P ≤ 0.001), and have hypertension (46.2% vs. 33.1%, P = 0.010). Following propensity score matching, 109 cases were selected for each cohort, with no significant differences in demographics, comorbidities, operation time, or outpatient status. The anemic cohort was independently associated with an increase in overall postoperative complications (17.4% vs. 7.3%, P = 0.038). Transfusion use was significantly associated with preoperative hematocrit levels <30 (30.0% vs. 4.5%, P = 0.001) and between 30 and 34.99 (13.9% vs. 2.5%, P = 0.011).Conclusion: Preoperative anemia is a significant predictor of overall complications and bleeding requiring transfusion for patients undergoing ESS. These results highlight the need for careful preoperative assessment and management of anemia in this population.

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Section: Discussionsupporting

confidence: 93%

Anemia and blood transfusion requirements in endoscopic sinus surgery: A propensity‐matched analysis

et al. 2019

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“…Prior literature has shown similar associations between pre- and postoperative transfusion and morbidity and mortality [ 8 ]. In the preoperative setting, Gabriel et al used a sample of noncardiac surgical cases from NSQIP to show an independent association between preoperative and perioperative transfusion with mortality.…”

Section: Discussionmentioning

confidence: 83%

“…Other studies have compared liberal (hemoglobin < 10 g/dL) and restrictive (hemoglobin < 8 g/dL or symptomatic) transfusion guidelines in an attempt to discern at which point the harm of transfusion outweighs the benefits. Carson et al demonstrated no difference in mortality, inability to walk at 60-day follow-up, or in-hospital morbidity between liberal and restrictive transfusion groups [ 8 , [21] , [22] , [23] , [24] , [25] ]. Additionally, Murphy et al focused on a cohort of cardiac patients and showed no difference in morbidity and health care costs between liberal and restrictive transfusion guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown varying degrees of association between preoperative anemia and adverse postoperative outcomes, including increased length of stay; rates of readmission, infectious complications, respiratory failure, cardiac events, and deep venous thrombosis (DVT); and poorer functional status [ [2] , [3] , [4] , [5] , [6] , [7] ]. In addition to anemia, perioperative transfusion is independently associated with poor postoperative outcomes including mortality [ 1 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Is preoperative anemia a significant risk factor for splenectomy patients? A NSQIP analysis

Agathis

Khetan

Bitner

et al. 2020

Surgery Open Science

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Background Prior literature has examined the association between preoperative anemia and complications across surgical settings; however, evidence is lacking for splenectomy patients. We investigated the association between preoperative hematocrit and 30-day postoperative outcomes in this population using a national database. Methods Patients who underwent splenectomy (2012–2017) were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Analyses were performed for the overall cohort and elective versus emergent subsets, adjusting for transfusion among other covariates. Results Our sample included 5,580 patients. As hematocrit decreased, complication rates increased incrementally in both the univariate and multivariate analyses. Adjusted odds ratios (and 95% confidence intervals) for moderate anemia (26% ≤ hematocrit < 30%) as compared to no anemia (hematocrit ≥ 38%) were readmission = 1.5 (1.1–1.8), sepsis = 2.2 (1.6–3.0), and composite outcome = 1.8 (1.0–3.2). Parameter estimates (standard error, P value) for the moderate versus no anemia group were length of stay = 3.0 (0.5, P < .001) and days to discharge = 1.2 (0.3; P < .001). Conclusion Our results demonstrate a dose-response relationship between increasing degree of anemia and odds of various postoperative adverse outcomes after adjusting for several potential confounders. The subset analysis further suggests that elective splenectomy cases are more likely to have poor outcomes when in the presence of anemia or when transfusions are performed as compared to emergent cases. This suggests that the harm associated with transfusion may offset the benefit of optimizing anemia in an elective splenectomy case.

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“…We could also not control for perioperative blood transfusions. It is likely, however, that blood administration and anaemia are both independently associated with postoperative mortality, [15] and we therefore believe that this weakness should not compromise the interpretation of our findings. Furthermore, it is also possible that the prevalence and severity of preoperative anaemia may have been underestimated in this study, owing to preoperative transfusions.…”

Section: Researchmentioning

confidence: 81%

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

et al. 2018

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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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The Association of Preoperative Hematocrit and Transfusion with Mortality in Patients Undergoing Elective Non‐cardiac Surgery

Abstract: Healthcare providers making preoperative clinical decisions for patients undergoing elective surgery should consider the degree of preoperative anemia and likelihood of perioperative transfusion.

Cited by 24 publications

References 24 publications

Anemia and blood transfusion requirements in endoscopic sinus surgery: A propensity‐matched analysis

Anemia and blood transfusion requirements in endoscopic sinus surgery: A propensity‐matched analysis

Is preoperative anemia a significant risk factor for splenectomy patients? A NSQIP analysis

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

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