The association of pre-operative anaemia with morbidity and mortality after emergency laparotomy.
Aged
Anemia
/ blood
Digestive System Surgical Procedures
/ adverse effects
Emergencies
Female
Hemoglobins
/ metabolism
Humans
Length of Stay
/ statistics & numerical data
Male
Medical Audit
/ methods
Middle Aged
Morbidity
Postoperative Complications
/ etiology
Preoperative Period
ROC Curve
Reoperation
/ statistics & numerical data
Severity of Illness Index
United Kingdom
/ epidemiology
anaemia and coagulation
peri-operative management
Journal
Anaesthesia
ISSN: 1365-2044
Titre abrégé: Anaesthesia
Pays: England
ID NLM: 0370524
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
accepted:
10
02
2020
pubmed:
22
4
2020
medline:
3
7
2020
entrez:
22
4
2020
Statut:
ppublish
Résumé
Pre-operative anaemia is associated with poor outcomes after elective surgery but its relationship with outcomes after emergency surgery is unclear. We analysed National Emergency Laparotomy Audit data from 1 December 2013 to 30 November 2017, excluding laparotomy for haemorrhage. Anaemia was classified as 'mild' 129-110 g.l-1; 'moderate' 109-80 g.l-1; or 'severe' ≤ 79 g.l-1. The primary outcome was 90-day mortality. Secondary outcomes were 30-day mortality, return to theatre and postoperative hospital stay. The primary outcome was available for 86,763 patients, of whom 45,306 (52%) were anaemic. There were 12,667 (15%) deaths at 90 postoperative days and 9246 (11%) deaths at 30 postoperative days. Anaemia was associated with increased 90-day and 30-day mortality, odds ratio (95%CI): mild, 1.15 (1.09-1.21); moderate, 1.44 (1.36-1.52); and severe, 1.42 (1.24-1.63), p < 0.001 for all; mild, 1.07 (1.00-1.12), p = 0.030; moderate, 1.30 (1.21-1.38), p < 0.001; and severe, 1.22 (1.05-1.43), p = 0.010, respectively. All categories of anaemia were associated with prolonged hospital stay, adjusted coefficient (95%CI): mild, 1.31 (1.01-1.62); moderate, 3.41 (3.04-3.77); severe, 2.80 (1.83-3.77), p < 0.001 for all. Moderate and severe anaemia were associated with increased risk of return to the operating theatre, odds ratio (95%CI): moderate 1.13 (1.06-1.21), p < 0.001; and severe 1.23 (1.06-1.43), p = 0.006. Pre-operative anaemia is common in patients undergoing emergency laparotomy and is associated with increased postoperative mortality and morbidity.
Substances chimiques
Hemoglobins
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
904-912Subventions
Organisme : NIHR Doctoral Research Fellowship
ID : DRF-2017-10-094
Pays : International
Informations de copyright
© 2020 Association of Anaesthetists.
Références
Meara JG, Leather AJ, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Surgery 2015; 158: 3-6.
Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A. Global burden of postoperative death. Lancet 2019; 393: 401.
International Surgical Outcomes Study. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. British Journal of Anaesthesia 2016; 117: 601-9.
Ackland GL, Abbott TEF, Cain D, et al. Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery. British Journal of Anaesthesia 2019; 122: 180-7.
Ackland GL, Iqbal S, Paredes LG, et al. Individualised oxygen delivery targeted haemodynamic therapy in high-risk surgical patients: a multicentre, randomised, double-blind, controlled, mechanistic trial. Lancet Respiratory Medicine 2015; 3: 33-41.
Wijeysundera DN, Pearse RM, Shulman MA, et al. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study. Lancet 2018; 391: 2631-40.
Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. British Journal of Surgery 2015; 102: 1314-24.
Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 2011; 378: 1396-407.
Fowler AJ, Ahmad T, Abbott TEF, et al. Association of preoperative anaemia with postoperative morbidity and mortality: an observational cohort study in low-, middle-, and high-income countries. British Journal of Anaesthesia 2018; 121: 1227-35.
Mueller MM, Van Remoortel H, Meybohm P, et al. Patient Blood Management: recommendations from the 2018 Frankfurt Consensus Conference. Journal of the American Medical Association 2019; 321: 983-97.
Munoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia 2017; 72: 233-47.
Munoz M, Acheson AG, Bisbe E, et al. An international consensus statement on the management of postoperative anaemia after major surgical procedures. Anaesthesia 2018; 73: 1418-31.
Eugene N, Oliver CM, Bassett MG, et al. Development and internal validation of a novel risk adjustment model for adult patients undergoing emergency laparotomy surgery: the National Emergency Laparotomy Audit risk model. British Journal of Anaesthesia 2018; 121: 739-48.
Poulton T, Murray D. Pre-optimisation of patients undergoing emergency laparotomy: a review of best practice. Anaesthesia 2019; 74(Suppl. 1): 100-7.
Stoneham M, Murray D, Foss N. Emergency surgery: the big three-abdominal aortic aneurysm, laparotomy and hip fracture. Anaesthesia 2014; 69(Suppl. 1): 70-80.
von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453-7.
National Emergency Laparotomy Audit (NELA) Project Team. The Second Patient National Emergency Laparotomy Audit (NELA) Report. December 2014 - November 2015. https://www.nela.org.uk/Second-Patient-Report-of-the-National-Emergency-Laparotomy-Audit#pt (accessed 01/12/2018).
National Emergency Laparotomy Audit (NELA) Project Team. The Third Patient National Emergency Laparotomy Audit (NELA) Report. December 2015-November 2016. https://www.nela.org.uk/Third-Patient-Audit-Report#pt (accessed 01/12/2018).
National Emergency Laparotomy Audit (NELA) Project Team. The Fourth Patient National Emergency Laparotomy Audit (NELA) Report. December 2016-November 2017. https://www.nela.org.uk/Fourth-Patient-Audit-Report#pt (accessed 01/12/2018).
World Health Organization (WHO). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011. https://www.who.int/vmnis/indicators/haemoglobin.pdf (accessed 01/11/2018).
Butcher A, Richards T, Stanworth SJ, Klein AA. Diagnostic criteria for pre-operative anaemia-time to end sex discrimination. Anaesthesia 2017; 72: 811-14.
Dixon WJ. Simplified estimation from censored normal samples. The Annals of Mathematical Statististics 1960; 31: 385-91.
Wu WC, Schifftner TL, Henderson WG, et al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. Journal of the American Medical Association 2007; 297: 2481-8.
Potter LJ, Doleman B, Moppett IK. A systematic review of pre-operative anaemia and blood transfusion in patients with fractured hips. Anaesthesia 2015; 70: 483-500.
Shander A, Javidroozi M, Ozawa S, Hare GM. What is really dangerous: anaemia or transfusion? British Journal of Anaesthesia 2011; 107(Suppl. 1): i41-59.
Baron DM, Hochrieser H, Posch M, et al. Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients. British Journal of Anaesthesia 2014; 113: 416-23.
Roubinian NH, Murphy EL, Mark DG, et al. Long-term outcomes among patients discharged from the hospital with moderate anemia: a retrospective cohort study. Annals of Internal Medicine 2019; 170: 81-9.
National Emergency Laparotomy Audit. NELA collaborations document. 2019. https://www.nela.org.uk/NELA_Research (accessed 09/09/2019).
Staibano P, Perelman I, Lombardi J, et al. Patient-centered outcomes in the management of anemia: a scoping review. Transfusion Medicine Reviews 2019; 33: 7-11.
Keeler BD, Dickson EA, Simpson JA, et al. The impact of pre-operative intravenous iron on quality of life after colorectal cancer surgery: outcomes from the intravenous iron in colorectal cancer-associated anaemia (IVICA) trial. Anaesthesia 2019; 74: 714-25.
Glance LG, Dick AW, Mukamel DB, et al. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology 2011; 114: 283-92.
Rohde JM, Dimcheff DE, Blumberg N, et al. Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. Journal of the American Medical Association 2014; 311: 1317-26.
Shah A, Sugavanam A, Reid J, et al. Risk of infection associated with intravenous iron preparations: protocol for updated a systematic review. British Medical Journal Open 2019; 9: e024618.
Shah A, Palmer AJR, Fisher SA, et al. What is the effect of perioperative intravenous iron therapy in patients undergoing non-elective surgery? A systematic review with meta-analysis and trial sequential analysis. Perioperative Medicine 2018; 7: 30.
Bregman DB, Morris D, Koch TA, He A, Goodnough LT. Hepcidin levels predict nonresponsiveness to oral iron therapy in patients with iron deficiency anemia. American Journal of Hematolology 2013; 88: 97-101.
Litton E, Baker S, Erber W, et al. Hepcidin predicts response to IV iron therapy in patients admitted to the intensive care unit: a nested cohort study. Journal of Intensive Care 2018; 6: 60.
Steensma DP, Sasu BJ, Sloan JA, Tomita DK, Loprinzi CL. Serum hepcidin levels predict response to intravenous iron and darbepoetin in chemotherapy-associated anemia. Blood 2015; 125: 3669-71.
Spahn DR, Schoenrath F, Spahn GH, et al. Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial. Lancet 2019; 393: 2201-12.