title: Effect of Pre-operative Anaemia on Post-operative Complications in Low-Resource Settings.
abstract: In high-resource settings, even mild anaemia is associated with an increased risk of post-operative complications. Whether this is true in low-resource settings is unclear. We aimed to evaluate the effect of anaemia on surgical outcomes in the Republic of Congo and Madagascar.
  
  
  
  It is a retrospective chart review of 2064 non-pregnant patients undergoing elective surgery with Mercy Ships. Logistic regression was used to determine the association between pre-operative anaemia and pre-defined surgical complications, adjusted for age, gender, surgical specialty, and country.
  
  
  
  The average age of patients was 27.2 years; 56.7% were male. Sixty-two percent of patients were not anaemic, and 22.7, 13.9 and 1.4% met sex-related criteria for mild, moderate and severe anaemia, respectively. In adjusted analyses, the severe anaemia group had an 8.58 [3.65, 19.49] higher odds of experiencing any surgical complication (p < 0.001) compared to non-anaemic patients. Analysis of each complication showed a 33.13 [9.57, 110.39] higher odds of unexpected ICU admission (p < 0.001); a 7.29 [1.98, 21.45] higher odds of surgical site infection (p < 0.001); and 7.48 [1.79, 25.78] higher odds of requiring hospital readmission (p < 0.001). Evaluating other anaemia categories, only those with moderate anaemia had a higher risk of requiring ICU admission (odds ratio 2.75 [1.00, 7.04], p = 0.04) compared to those without anaemia.
  
  
  
  Our results indicate that in low-income settings, severe anaemia is associated with an increased risk of post-operative complications including unexpected ICU admission, surgical site infection and hospital readmission, whereas mild anaemia was not associated with increased post-operative complications.
authors.affiliation: M/V Africa Mercy, Mercy Ships, Port au Toamasina, Toamasina, Madagascar. doctormcw@gmail.com.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: White
authors.affiliation: M/V Africa Mercy, Mercy Ships, Port au Toamasina, Toamasina, Madagascar.
authors.forename: Lydia
authors.initials: L
authors.lastname: Longstaff
authors.affiliation: Massachusetts General Hospital, Boston, MA, 02114, USA.
authors.forename: Peggy S
authors.initials: PS
authors.lastname: Lai
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D000740:Anemia / Q000453:epidemiology*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008493:Medical Missions; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult