title: Impact of Preoperative Anaemia and Blood Transfusion on Postoperative Outcomes in Gynaecological Surgery.
abstract: OBJECTIVE
  To evaluate the effect of preoperative anaemia and blood transfusion on 30-day postoperative morbidity and mortality in patients undergoing gynecological surgery.
  
  
  METHODS
  Data were analyzed from 12,836 women undergoing operation in the American College of Surgeons National Surgical Quality Improvement Program. Outcomes measured were; 30-day postoperative mortality, composite and specific morbidities (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thrombosis, or major bleeding). Multivariate logistic regression models were performed using adjusted odds ratios (ORadj) to assess the independent effects of preoperative anaemia (hematocrit <36.0%) on outcomes, effect estimates were performed before and after adjustment for perioperative transfusion requirement.
  
  
  RESULTS
  The prevalence of preoperative anaemia was 23.9% (95%CI: 23.2-24.7). Adjusted for confounders by multivariate logistic regression; preoperative anaemia was independently and significantly associated with increased odds of 30-day mortality (OR: 2.40, 95%CI: 1.06-5.44) and composite morbidity (OR: 1.80, 95%CI: 1.45-2.24). This was reflected by significantly higher adjusted odds of almost all specific morbidities including; respiratory, central nervous system, renal, wound, sepsis, and venous thrombosis. Blood Transfusion increased the effect of preoperative anaemia on outcomes (61% of the effect on mortality and 16% of the composite morbidity).
  
  
  CONCLUSIONS
  Preoperative anaemia is associated with adverse post-operative outcomes in women undergoing gynecological surgery. This risk associated with preoperative anaemia did not appear to be corrected by use of perioperative transfusion.
authors.affiliation: Division of Surgery and Interventional Science, University College London Hospital, London, United Kingdom.
authors.forename: Toby
authors.initials: T
authors.lastname: Richards
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Musallam
authors.affiliation: Department of Obstetrics and Gynaecology, American University of Beirut Medical Centre, Beirut, Lebanon.
authors.forename: Joseph
authors.initials: J
authors.lastname: Nassif
authors.affiliation: Department of Obstetrics and Gynaecology, American University of Beirut Medical Centre, Beirut, Lebanon.
authors.forename: Ghina
authors.initials: G
authors.lastname: Ghazeeri
authors.affiliation: Department of Obstetrics and Gynaecology, American University of Beirut Medical Centre, Beirut, Lebanon.
authors.forename: Muhieddine
authors.initials: M
authors.lastname: Seoud
authors.affiliation: Division of Surgery and Interventional Science, University College London Hospital, London, United Kingdom.
authors.forename: Kurinchi S
authors.initials: KS
authors.lastname: Gurusamy
authors.affiliation: Department of Surgery, American University of Beirut Medical Centre, Beirut, Lebanon.
authors.forename: Faek R
authors.initials: FR
authors.lastname: Jamali
mesh_terms: D000328:Adult; D000740:Anemia / Q000503:physiopathology* / Q000628:therapy; D001803:Blood Transfusion; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies