Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients.
BACKGROUND
Retrospective studies suggest that preoperative anaemia is associated with poor outcomes after surgery. The objective of this study was to describe mortality rates and patterns of intensive care resource use for patients with anaemia undergoing non-cardiac and non-neurological in-patient surgery.


METHODS
We performed a secondary analysis of a large prospective study describing perioperative care and survival in 28 European nations. Patients at least 16 yr old undergoing in-patient surgery during a 7 day period were included in the study. Data were collected for in-hospital mortality, duration of hospital stay, admission to intensive care, and intensive care resource use. Multivariable logistic regression analysis was performed to understand the effects of preoperative haemoglobin (Hb) levels on in-hospital mortality.


RESULTS
We included 39 309 patients in the analysis. Preoperative anaemia had a high prevalence in both men and women (31.1% and 26.5%, respectively). Multivariate analysis showed that patients with severe [odds ratio 2.82 (95% confidence interval 2.06-3.85)] or moderate [1.99 (1.67-2.37)] anaemia had higher in-hospital mortality than those with normal preoperative Hb concentrations. Furthermore, hospital length of stay (P<0.001) and postoperative admission to intensive care (P<0.001) were greater in patients with anaemia than in those with normal Hb concentrations.


CONCLUSIONS
Anaemia is common among non-cardiac and non-neurological surgical patients, and is associated with poor clinical outcome and increased healthcare resource use.


BACKGROUND
NCT01203605 (ClinicalTrials.gov).
Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria.
D M
DM
Baron
Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
H
H
Hochrieser
Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
M
M
Posch
Austrian Center for Documentation and Quality Management in Intensive Care Medicine, Vienna, Austria.
B
B
Metnitz
Intensive Care Medicine, St Georges Healthcare NHS Trust and St Georges University of London, St Georges Hospital, London, UK philipp@metnitz.biz andrewrhodes@nhs.net.
A
A
Rhodes
UCINC, Hospital de São José, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal.
R P
RP
Moreno
Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
R M
RM
Pearse
Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria philipp@metnitz.biz andrewrhodes@nhs.net.
P
P
Metnitz
D000740:Anemia / Q000453:epidemiology*; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*
anaemia; assessment, outcome; care, intensive; epidemiologic studies, cohort studies; mortality determinants