The association between preoperative anemia and postoperative morbidity in pediatric surgical patients: A secondary analysis of a prospective observational cohort study.
adverse effects
anemia
complication
pediatric surgery
perioperative period
surgery
Journal
Paediatric anaesthesia
ISSN: 1460-9592
Titre abrégé: Paediatr Anaesth
Pays: France
ID NLM: 9206575
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
09
08
2019
revised:
23
03
2020
accepted:
28
03
2020
pubmed:
11
4
2020
medline:
29
7
2021
entrez:
11
4
2020
Statut:
ppublish
Résumé
The prevalence of anemia in the South African pediatric surgical population is unknown. Anemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low- and middle-income countries (LMICs). The primary aim of this study was to describe the association between preoperative anemia and 26 defined postoperative complications, in noncardiac pediatric surgical patients. Secondary aims included describing the prevalence of anemia and risk factors for intraoperative blood transfusion. This was a secondary analysis of the South African Paediatric Surgical Outcomes Study, a prospective, observational surgical outcomes study. Inclusion criteria were all consecutive patients aged between 6 months and <16 years, presenting to participating centers during the study period who underwent elective and nonelective noncardiac surgery and had a preoperative hemoglobin recorded. Exclusion criteria were patients aged <6 months, undergoing cardiac surgery, or without a preoperative Hb recorded. To determine whether an independent association existed between preoperative anemia and postoperative complications, a hierarchical stepwise logistic regression was conducted. There were 1094 eligible patients. In children in whom a preoperative Hb was recorded 46.2% had preoperative anemia. Preoperative anemia was independently associated with an increased risk of any postoperative complication (odds ratio 2.0, 95% confidence interval: 1.3-3.1, P = .002). Preoperative anemia (odds ratio 3.6, 95% confidence interval: 1.8-7.1, P < .001) was an independent predictor of intraoperative blood transfusion. Preoperative anemia had a high prevalence in a LMIC and was associated with increased postoperative complications. The main limitation of our study is the ability to generalize the results to the wider pediatric surgical population, as these findings only relate to children in whom a preoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anemia reduces morbidity and mortality in children undergoing noncardiac surgery.
Sections du résumé
BACKGROUND
The prevalence of anemia in the South African pediatric surgical population is unknown. Anemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low- and middle-income countries (LMICs).
AIM
The primary aim of this study was to describe the association between preoperative anemia and 26 defined postoperative complications, in noncardiac pediatric surgical patients. Secondary aims included describing the prevalence of anemia and risk factors for intraoperative blood transfusion.
METHOD
This was a secondary analysis of the South African Paediatric Surgical Outcomes Study, a prospective, observational surgical outcomes study. Inclusion criteria were all consecutive patients aged between 6 months and <16 years, presenting to participating centers during the study period who underwent elective and nonelective noncardiac surgery and had a preoperative hemoglobin recorded. Exclusion criteria were patients aged <6 months, undergoing cardiac surgery, or without a preoperative Hb recorded. To determine whether an independent association existed between preoperative anemia and postoperative complications, a hierarchical stepwise logistic regression was conducted.
RESULTS
There were 1094 eligible patients. In children in whom a preoperative Hb was recorded 46.2% had preoperative anemia. Preoperative anemia was independently associated with an increased risk of any postoperative complication (odds ratio 2.0, 95% confidence interval: 1.3-3.1, P = .002). Preoperative anemia (odds ratio 3.6, 95% confidence interval: 1.8-7.1, P < .001) was an independent predictor of intraoperative blood transfusion.
CONCLUSION
Preoperative anemia had a high prevalence in a LMIC and was associated with increased postoperative complications. The main limitation of our study is the ability to generalize the results to the wider pediatric surgical population, as these findings only relate to children in whom a preoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anemia reduces morbidity and mortality in children undergoing noncardiac surgery.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
759-765Investigateurs
K Allopi
(K)
U Singh
(U)
P Diyelela-Ndwandwa
(P)
N Nongqo
(N)
B Ravid
(B)
P Anamourlis
(P)
G Coetzee
(G)
M Dlamini
(M)
C Foster
(C)
P Mogane
(P)
D Nel
(D)
A Oosthuizen
(A)
L Redford
(L)
R Murray
(R)
C Basson
(C)
J Joubert
(J)
N Tshifularo
(N)
T Els
(T)
J Orrock
(J)
M Muthambi
(M)
T Matebesi
(T)
G Tshukudu
(G)
D Maela
(D)
N Allorto
(N)
J Bertie
(J)
D Bishop
(D)
K Chetty
(K)
M Grobbelaar
(M)
R Wise
(R)
I von Steiger
(I)
P Nundlal
(P)
E Garoufalias
(E)
G Westcott
(G)
J Davids
(J)
C Rajah
(C)
R Rodseth
(R)
C Cairns
(C)
Y Mzoneli
(Y)
K Bhagwan
(K)
E Cloete
(E)
M Jaworska
(M)
E Semenya
(E)
O Porrill
(O)
R Mungar
(R)
P Seonandan
(P)
N Perumal
(N)
C Alphonsus
(C)
M Bosman
(M)
A De Castro
(A)
L Drummond
(L)
M Du Bruyn
(M)
P Govender
(P)
T Hardcastle
(T)
Z Hlangu
(Z)
P Jeena
(P)
M Mbuyisa
(M)
T Naidu
(T)
J Sewlall
(J)
J Taylor
(J)
K Timakia
(K)
W Van der Walt
(W)
T Biyase
(T)
Z Khumalo
(Z)
B Kusel
(B)
I Mukama
(I)
M Ramburuth
(M)
S Singaram
(S)
M Mbeki
(M)
H Schutte
(H)
P Anderson
(P)
B Dorasamy
(B)
P Kint
(P)
S Goga
(S)
L Cronjé
(L)
N Dube
(N)
S Jithoo
(S)
L Naidoo
(L)
L Naidu
(L)
T Reddy
(T)
Y Saman
(Y)
D Rungan
(D)
K Naidoo
(K)
K Kabambi
(K)
N Mgoqo
(N)
M Mofoka
(M)
A Usenbo
(A)
C Chiu
(C)
N Machere
(N)
D Maiwald
(D)
G Davies
(G)
T Serdyn
(T)
P Gokal
(P)
N Dhanjee
(N)
M Wege
(M)
S Govender
(S)
S Tarr
(S)
M Moodley
(M)
M Balkisson
(M)
A Maharaj
(A)
S Ngcobo
(S)
N Rorke
(N)
S Sikhakhane
(S)
M Khumalo
(M)
T Ramsamy
(T)
K Kabongo
(K)
W Kuhn
(W)
R Matos-Puig
(R)
R Naidoo
(R)
A Thotharam
(A)
A Chohan
(A)
S Adam
(S)
I Appel
(I)
A Burke
(A)
C de Vos
(C)
S Gautam
(S)
E Joubert
(E)
R Rautenbach
(R)
D Roytowski
(D)
A Szpytko
(A)
E Brits
(E)
G Naude
(G)
J van Niekerk
(J)
Z Fullerton
(Z)
Informations de copyright
© 2020 John Wiley & Sons Ltd.
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