Postoperative anaemia might be a risk factor for postoperative delirium and prolonged hospital stay: A secondary analysis of a prospective cohort study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
13
08
2019
accepted:
25
01
2020
entrez:
22
2
2020
pubmed:
23
2
2020
medline:
10
5
2020
Statut:
epublish
Résumé
Postoperative anaemia is a frequent surgical complication and in contrast to preoperative anaemia has not been validated in relation to mortality, morbidity and its associated health economic effect. Postoperative anaemia can predispose postoperative delirium through impairment of cerebral oxygenation. The aim of this secondary analysis is to investigate the association of postoperative anaemia in accordance with the sex specific World Health Organization definition of anaemia to postoperative delirium and its impact on the duration of hospital stay. A secondary analysis of the prospective multicentric observational CESARO-study was conducted. 800 adult patients undergoing elective surgery were enrolled from various operative disciplines across seven hospitals ranging from university hospitals, district general hospitals to specialist clinics of minimally invasive surgery in Germany. Patients were classified as anaemic according to the World Health Organization parameters, setting the haemoglobin level cut off below 12g/dl for females and below 13g/dl for males. Focus of the investigation were patients with acute anaemia. Patients with present preoperative anaemia or missing haemoglobin measurement were excluded from the sample set. Delirium screening was established postoperatively for at least 24 hours and up to three days, applying the validated Nursing Delirium Screening Scale. The initial sample set contained 800 patients of which 183 were suitable for analysis in the study. Ninety out of 183 (49.2%) suffered from postoperative anaemia. Ten out of 93 (10.9%) patients without postoperative anaemia developed a postoperative delirium. In the group with postoperative anaemia, 28 (38.4%) out of 90 patients suffered from postoperative delirium (odds ratio 3.949, 95% confidence interval, (1.358-11.480)) after adjustment for NYHA-stadium, severity of surgery, cutting/suture time, duration of anaesthesia, transfusion of packed red cells and sedation status with Richmond Agitation Scale after surgery. Additionally, patients who suffered from postoperative anaemia showed a significantly longer duration of hospitalisation (7.75 vs. 12.42 days, odds ratio = 1.186, 95% confidence interval, 1.083-1.299, after adjustments). The study results reveal that postoperative anaemia is not only a frequent postsurgical complication with an incidence probability of almost 50%, but could also be associated with a postoperative delirium and a prolonged hospitalisation.
Sections du résumé
BACKGROUND
Postoperative anaemia is a frequent surgical complication and in contrast to preoperative anaemia has not been validated in relation to mortality, morbidity and its associated health economic effect. Postoperative anaemia can predispose postoperative delirium through impairment of cerebral oxygenation. The aim of this secondary analysis is to investigate the association of postoperative anaemia in accordance with the sex specific World Health Organization definition of anaemia to postoperative delirium and its impact on the duration of hospital stay.
METHODS
A secondary analysis of the prospective multicentric observational CESARO-study was conducted. 800 adult patients undergoing elective surgery were enrolled from various operative disciplines across seven hospitals ranging from university hospitals, district general hospitals to specialist clinics of minimally invasive surgery in Germany. Patients were classified as anaemic according to the World Health Organization parameters, setting the haemoglobin level cut off below 12g/dl for females and below 13g/dl for males. Focus of the investigation were patients with acute anaemia. Patients with present preoperative anaemia or missing haemoglobin measurement were excluded from the sample set. Delirium screening was established postoperatively for at least 24 hours and up to three days, applying the validated Nursing Delirium Screening Scale.
RESULTS
The initial sample set contained 800 patients of which 183 were suitable for analysis in the study. Ninety out of 183 (49.2%) suffered from postoperative anaemia. Ten out of 93 (10.9%) patients without postoperative anaemia developed a postoperative delirium. In the group with postoperative anaemia, 28 (38.4%) out of 90 patients suffered from postoperative delirium (odds ratio 3.949, 95% confidence interval, (1.358-11.480)) after adjustment for NYHA-stadium, severity of surgery, cutting/suture time, duration of anaesthesia, transfusion of packed red cells and sedation status with Richmond Agitation Scale after surgery. Additionally, patients who suffered from postoperative anaemia showed a significantly longer duration of hospitalisation (7.75 vs. 12.42 days, odds ratio = 1.186, 95% confidence interval, 1.083-1.299, after adjustments).
CONCLUSION
The study results reveal that postoperative anaemia is not only a frequent postsurgical complication with an incidence probability of almost 50%, but could also be associated with a postoperative delirium and a prolonged hospitalisation.
Identifiants
pubmed: 32084207
doi: 10.1371/journal.pone.0229325
pii: PONE-D-19-22270
pmc: PMC7034819
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0229325Déclaration de conflit d'intérêts
The CESARO study group received funding from “Dr. Franz Köhler Chemie GmbH” (Bensheim, Germany). This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Références
Eur J Anaesthesiol. 2017 Apr;34(4):192-214
pubmed: 28187050
Clin Orthop Relat Res. 2004 May;(422):195-200
pubmed: 15187857
Spine (Phila Pa 1976). 1998 Apr 15;23(8):941-7; discussion 947-8
pubmed: 9580963
Lancet. 2011 Oct 15;378(9800):1396-407
pubmed: 21982521
Lancet Respir Med. 2018 Mar;6(3):213-222
pubmed: 29508705
Can J Anaesth. 2012 Mar;59(3):304-20
pubmed: 22311257
J Patient Saf. 2017 Dec;13(4):202-206
pubmed: 25186980
Eur J Anaesthesiol. 2011 Nov;28(11):796-801
pubmed: 21885979
JAMA. 2003 Jun 11;289(22):2983-91
pubmed: 12799407
Crit Care. 2013 Oct 29;17(5):R257
pubmed: 24168808
Vasc Med. 2017 Oct;22(5):387-397
pubmed: 28784053
J Clin Epidemiol. 1996 Dec;49(12):1373-9
pubmed: 8970487
Br J Anaesth. 2008 Sep;101(3):338-43
pubmed: 18603528
World J Surg. 2019 Jul;43(7):1677-1691
pubmed: 30824959
Am J Med. 1998 Nov;105(5):380-4
pubmed: 9831421
Br J Surg. 2003 Feb;90(2):157-65
pubmed: 12555290
Anesthesiology. 2011 Feb;114(2):283-92
pubmed: 21239971
Crit Care Med. 2015 Aug;43(8):e276-86
pubmed: 25860202
Surg Technol Int. 2005;14:281-6
pubmed: 16525984
J Am Med Dir Assoc. 2016 Aug 1;17(8):748-53
pubmed: 27233490
Br J Surg. 2015 Oct;102(11):1314-24
pubmed: 26349842
Am J Surg. 2017 Dec;214(6):1036-1038
pubmed: 28947274
J Orthop Trauma. 2004 Jul;18(6):369-74
pubmed: 15213502
Eur J Anaesthesiol. 2015 Mar;32(3):160-7
pubmed: 25564780
Intensive Care Med. 2016 Jan;42(1):3-15
pubmed: 26564211
Spine J. 2006 Mar-Apr;6(2):164-9
pubmed: 16517388
JAMA. 1996 Mar 20;275(11):852-7
pubmed: 8596223
Eur J Anaesthesiol. 2019 Feb;36(2):114-122
pubmed: 30431498
World J Surg. 2010 Mar;34(3):487-94
pubmed: 20066416
Am J Geriatr Psychiatry. 2013 Dec;21(12):1190-222
pubmed: 24206937
Dan Med J. 2015 Dec;62(12):A5170
pubmed: 26621400
Eur J Anaesthesiol. 2015 Mar;32(3):147-51
pubmed: 24979586
Arch Orthop Trauma Surg. 2005 Jun;125(5):342-7
pubmed: 15789233
Bosn J Basic Med Sci. 2019 Feb 12;19(1):81-85
pubmed: 29984677
Clin Orthop Surg. 2018 Mar;10(1):20-25
pubmed: 29564043
Anesth Analg. 2016 Jun;122(6):1923-8
pubmed: 26451518
Psychosomatics. 2006 Jan-Feb;47(1):56-61
pubmed: 16384808
Alzheimers Dement. 2016 Jul;12(7):766-75
pubmed: 27103261
J Am Geriatr Soc. 2013 Mar;61(3):365-70
pubmed: 23496244
Crit Care Med. 2017 Aug;45(8):1295-1303
pubmed: 28481752
Aging Clin Exp Res. 2017 Jun;29(3):459-466
pubmed: 27251666
Ann Surg. 2015 Jun;261(6):1207-14
pubmed: 24887982
J Pain Symptom Manage. 2005 Apr;29(4):368-75
pubmed: 15857740
Spine (Phila Pa 1976). 2012 Oct 1;37(21):E1336-42
pubmed: 22772572
Spine J. 2017 Jul;17(7):977-982
pubmed: 28323241