The effects of preoperative moderate to severe anaemia on length of hospital stay: A propensity score-matched analysis in non-cardiac surgery patients.
Journal
European journal of anaesthesiology
ISSN: 1365-2346
Titre abrégé: Eur J Anaesthesiol
Pays: England
ID NLM: 8411711
Informations de publication
Date de publication:
01 06 2021
01 06 2021
Historique:
pubmed:
6
1
2021
medline:
14
5
2021
entrez:
5
1
2021
Statut:
ppublish
Résumé
Anaemia is frequently recorded during preoperative screening and has been suggested to affect outcomes after surgery negatively. The objectives were to assess the frequency of moderate to severe anaemia and its association with length of hospital stay. Post hoc analysis of the international observational prospective 'Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study. The current analysis included adult patients requiring general anaesthesia for non-cardiac surgery. Preoperative anaemia was defined as a haemoglobin concentration of 11 g dl-1 or lower, thus including moderate and severe anaemia according to World Health Organisation criteria. The primary outcome was length of hospital stay. Secondary outcomes included hospital mortality, intra-operative adverse events and postoperative pulmonary complications (PPCs). Haemoglobin concentrations were available for 8264 of 9864 patients. Preoperative moderate to severe anaemia was present in 7.7% of patients. Multivariable analysis showed that preoperative moderate to severe anaemia was associated with an increased length of hospital stay with a mean difference of 1.3 ((95% CI 0.8 to 1.8) days; P < .001). In the propensity-matched analysis, this association remained present, median 4.0 [IQR 1.0 to 5.0] vs. 2.0 [IQR 0.0 to 5.0] days, P = .001. Multivariable analysis showed an increased in-hospital mortality (OR 2.9 (95% CI 1.1 to 7.5); P = .029), and higher incidences of intra-operative hypotension (36.3 vs. 25.3%; P < .001) and PPCs (17.1 vs. 10.5%; P = .001) in moderately to severely anaemic patients. However, this was not confirmed in the propensity score-matched analysis. In this international cohort of non-cardiac surgical patients, preoperative moderate to severe anaemia was associated with a longer duration of hospital stay but not increased intra-operative complications, PPCs or in-hospital mortality. The LAS VEGAS study was registered at Clinicaltrials.gov, NCT01601223.
Sections du résumé
BACKGROUND
Anaemia is frequently recorded during preoperative screening and has been suggested to affect outcomes after surgery negatively.
OBJECTIVES
The objectives were to assess the frequency of moderate to severe anaemia and its association with length of hospital stay.
DESIGN
Post hoc analysis of the international observational prospective 'Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study.
PATIENTS AND SETTING
The current analysis included adult patients requiring general anaesthesia for non-cardiac surgery. Preoperative anaemia was defined as a haemoglobin concentration of 11 g dl-1 or lower, thus including moderate and severe anaemia according to World Health Organisation criteria.
MAIN OUTCOME MEASURES
The primary outcome was length of hospital stay. Secondary outcomes included hospital mortality, intra-operative adverse events and postoperative pulmonary complications (PPCs).
RESULTS
Haemoglobin concentrations were available for 8264 of 9864 patients. Preoperative moderate to severe anaemia was present in 7.7% of patients. Multivariable analysis showed that preoperative moderate to severe anaemia was associated with an increased length of hospital stay with a mean difference of 1.3 ((95% CI 0.8 to 1.8) days; P < .001). In the propensity-matched analysis, this association remained present, median 4.0 [IQR 1.0 to 5.0] vs. 2.0 [IQR 0.0 to 5.0] days, P = .001. Multivariable analysis showed an increased in-hospital mortality (OR 2.9 (95% CI 1.1 to 7.5); P = .029), and higher incidences of intra-operative hypotension (36.3 vs. 25.3%; P < .001) and PPCs (17.1 vs. 10.5%; P = .001) in moderately to severely anaemic patients. However, this was not confirmed in the propensity score-matched analysis.
CONCLUSIONS
In this international cohort of non-cardiac surgical patients, preoperative moderate to severe anaemia was associated with a longer duration of hospital stay but not increased intra-operative complications, PPCs or in-hospital mortality.
TRIAL REGISTRATION
The LAS VEGAS study was registered at Clinicaltrials.gov, NCT01601223.
Identifiants
pubmed: 33399375
doi: 10.1097/EJA.0000000000001412
pii: 00003643-202106000-00002
pmc: PMC9867571
mid: NIHMS1862766
doi:
Banques de données
ClinicalTrials.gov
['NCT01601223']
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
571-581Subventions
Organisme : NHLBI NIH HHS
ID : UH3 HL140177
Pays : United States
Informations de copyright
Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.
Références
Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood 2014; 123:615–624.
Bierbaum BE, Callaghan JJ, Galante JO, et al. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999; 81:2–10.
Goodnough LT, Vizmeg K, Sobecks R, et al. Prevalence and classification of anemia in elective orthopedic surgery patients: implications for blood conservation programs. Vox Sang 1992; 63:90–95.
Greenky M, Gandhi K, Pulido L, et al. Preoperative anemia in total joint arthroplasty: is it associated with periprosthetic joint infection? Clin Orthop Relat Res 2012; 470:2695–2701.
Heschl M, Gombotz H, Haslinger-Eisterer B, et al. The efficacy of preoperative preparation with intravenous iron and/or erythropoietin in anaemic patients undergoing orthopaedic surgery: an observational study. Eur J Anaesthesiol 2018; 35:289–297.
Lasocki S, Krauspe R, Heymann von C, et al. PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery. A multicentre, observational study. Eur J Anaesthesiol 2015; 32:160–167.
Klein AA, Collier TJ, Brar MS, et al. The incidence and importance of anaemia in patients undergoing cardiac surgery in the UK - the first Association of Cardiothoracic Anaesthetists’ national audit. Anaesthesia 2016; 71:627–635.
Feng S, Machina M, Beattie WS. Influence of anaemia and red blood cell transfusion on mortality in high cardiac risk patients undergoing major noncardiac surgery: a retrospective cohort study. Br J Anaesth 2017; 118:843–851.
Wu W-C, Schifftner TL, Henderson WG, et al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA 2007; 297:2481–2488.
Ludwig H, Van Belle S, Barrett-Lee P, et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer 2004; 40:2293–2306.
Wilson MJ, Dekker JWT, Buettner S, et al. The effect of intravenous iron therapy on long-term survival in anaemic colorectal cancer patients: results from a matched cohort study. Surg Oncol 2018; 27:192–199.
Melis M, McLoughlin JM, Dean EM, et al. Correlations between neoadjuvant treatment, anemia, and perioperative complications in patients undergoing esophagectomy for cancer. J Surg Res 2009; 153:114–120.
Beattie WS, Karkouti K, Wijeysundera DN, Tait G. Risk associated with preoperative anemia in noncardiac surgery: a single-center cohort study. Anesthesiology 2009; 110:574–581.
Saager L, Turan A, Reynolds LF, et al. The association between preoperative anemia and 30-day mortality and morbidity in noncardiac surgical patients. Anesth Analg 2013; 117:909–915.
Fowler AJ, Ahmad T, Phull MK, et al. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg 2015; 102:1314–1324.
LAS VEGAS investigators. Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries. Eur J Anaesthesiol 2017; 34:492–507.
World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System 2011; http://www.who.int/vmnis/indicators/haemoglobin.pdfhttp://www.who.int/vmnis/indicators/haemoglobin.pdf [Accessed 18 November 2020].
Baron DM, Hochrieser H, Posch M, et al. Preoperative anaemia is associated with poor clinical outcome in noncardiac surgery patients. Br J Anaesth 2014; 113:416–423.
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. Br J Anaesth 2018; 121:1227–1235.
Carson JL, Poses RM, Spence RK, Bonavita G. Severity of anaemia and operative mortality and morbidity. Lancet 1988; 1:727–729.
Tee MC, Shubert CR, Ubl DS, et al. Preoperative anemia is associated with increased use of hospital resources in patients undergoing elective hepatectomy. Surgery 2015; 158:1027–1038.
Ranucci M, Di Dedda U, Castelvecchio S, et al. Impact of preoperative anemia on outcome in adult cardiac surgery: a propensity-matched analysis. Ann Thorac Surg 2012; 94:1134–1141.
Gupta PK, Sundaram A, Mactaggart JN, et al. Preoperative anemia is an independent predictor of postoperative mortality and adverse cardiac events in elderly patients undergoing elective vascular operations. Ann Surg 2013; 258:1096–1102.
Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in noncardiac surgery: a retrospective cohort study. Lancet 2011; 378:1396–1407.
Kulier A, Levin J, Moser R, et al. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 2007; 116:471–479.
Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010; 113:1338–1350.
Tohme S, Varley PR, Landsittel DP, et al. Preoperative anemia and postoperative outcomes after hepatectomy. HPB 2016; 18:255–261.
Oshin OA, Torella F. Low hemoglobin concentration is associated with poor outcome after peripheral arterial surgery. Vasc Endovascular Surg 2013; 47:449–453.
Velescu A, Clará A, Cladellas M, et al. Anemia increases mortality after open or endovascular treatment in patients with critical limb ischemia: a retrospective analysis. Eur J Vasc Endovasc Surg 2016; 51:543–549.
Gabriel RA, Clark AI, Nguyen AP, et al. The association of preoperative hematocrit and transfusion with mortality in patients undergoing elective noncardiac surgery. World J Surg 2018; 42:1939–1948.
Bursi F, Barbieri A, Politi L, et al. Perioperative red blood cell transfusion and outcome in stable patients after elective major vascular surgery. Eur J Vasc Endovasc Surg 2009; 37:311–318.
Munting KE, Klein AA. Optimisation of preoperative anaemia in patients before elective major surgery - why, who, when and how? Anaesthesia 2019; 74 Suppl 1:49–57.
Muñoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia 2016; 72:233–247.
Mueller MM, Van Remoortel H, Meybohm P, et al. Patient blood management: recommendations from the 2018 Frankfurt consensus conference. JAMA 2019; 321:983–997.
Klein AA, Collier T, Yeates J, et al. The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery. Br J Anaesth 2017; 119:394–401.