Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study

Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We aimed to assess the effect of preoperative anaemia on 30-day postoperative morbidity and mortality in patients undergoing major non-cardiac surgery. We a...

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Published inThe Lancet (British edition) Vol. 378; no. 9800; pp. 1396 - 1407
Main Authors Musallam, Khaled M, Tamim, Hani M, Richards, Toby, Spahn, Donat R, Rosendaal, Frits R, Habbal, Aida, Khreiss, Mohammad, Dahdaleh, Fadi S, Khavandi, Kaivan, Sfeir, Pierre M, Soweid, Assaad, Hoballah, Jamal J, Taher, Ali T, Jamali, Faek R
Format Journal Article
LanguageEnglish
Published Kidlington Elsevier Ltd 15.10.2011
Elsevier
Elsevier Limited
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Abstract Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We aimed to assess the effect of preoperative anaemia on 30-day postoperative morbidity and mortality in patients undergoing major non-cardiac surgery. We analysed data for patients undergoing major non-cardiac surgery in 2008 from The American College of Surgeons' National Surgical Quality Improvement Program database (a prospective validated outcomes registry from 211 hospitals worldwide in 2008). We obtained anonymised data for 30-day mortality and morbidity (cardiac, respiratory, CNS, urinary tract, wound, sepsis, and venous thromboembolism outcomes), demographics, and preoperative and perioperative risk factors. We used multivariate logistic regression to assess the adjusted and modified (nine predefined risk factor subgroups) effect of anaemia, which was defined as mild (haematocrit concentration >29–<39% in men and >29–<36% in women) or moderate-to-severe (≤29% in men and women) on postoperative outcomes. We obtained data for 227 425 patients, of whom 69 229 (30·44%) had preoperative anaemia. After adjustment, postoperative mortality at 30 days was higher in patients with anaemia than in those without anaemia (odds ratio [OR] 1·42, 95% CI 1·31–1·54); this difference was consistent in mild anaemia (1·41, 1·30–1·53) and moderate-to-severe anaemia (1·44, 1·29–1·60). Composite postoperative morbidity at 30 days was also higher in patients with anaemia than in those without anaemia (adjusted OR 1·35, 1·30–1·40), again consistent in patients with mild anaemia (1·31, 1·26–1·36) and moderate-to-severe anaemia (1·56, 1·47–1·66). When compared with patients without anaemia or a defined risk factor, patients with anaemia and most risk factors had a higher adjusted OR for 30-day mortality and morbidity than did patients with either anaemia or the risk factor alone. Preoperative anaemia, even to a mild degree, is independently associated with an increased risk of 30-day morbidity and mortality in patients undergoing major non-cardiac surgery. Vifor Pharma.
AbstractList Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We aimed to assess the effect of preoperative anaemia on 30-day postoperative morbidity and mortality in patients undergoing major non-cardiac surgery. We analysed data for patients undergoing major non-cardiac surgery in 2008 from The American College of Surgeons' National Surgical Quality Improvement Program database (a prospective validated outcomes registry from 211 hospitals worldwide in 2008). We obtained anonymised data for 30-day mortality and morbidity (cardiac, respiratory, CNS, urinary tract, wound, sepsis, and venous thromboembolism outcomes), demographics, and preoperative and perioperative risk factors. We used multivariate logistic regression to assess the adjusted and modified (nine predefined risk factor subgroups) effect of anaemia, which was defined as mild (haematocrit concentration >29-<39% in men and >29-<36% in women) or moderate-to-severe (≤29% in men and women) on postoperative outcomes. We obtained data for 227,425 patients, of whom 69,229 (30·44%) had preoperative anaemia. After adjustment, postoperative mortality at 30 days was higher in patients with anaemia than in those without anaemia (odds ratio [OR] 1·42, 95% CI 1·31-1·54); this difference was consistent in mild anaemia (1·41, 1·30-1·53) and moderate-to-severe anaemia (1·44, 1·29-1·60). Composite postoperative morbidity at 30 days was also higher in patients with anaemia than in those without anaemia (adjusted OR 1·35, 1·30-1·40), again consistent in patients with mild anaemia (1·31, 1·26-1·36) and moderate-to-severe anaemia (1·56, 1·47-1·66). When compared with patients without anaemia or a defined risk factor, patients with anaemia and most risk factors had a higher adjusted OR for 30-day mortality and morbidity than did patients with either anaemia or the risk factor alone. Preoperative anaemia, even to a mild degree, is independently associated with an increased risk of 30-day morbidity and mortality in patients undergoing major non-cardiac surgery. Vifor Pharma.
Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We aimed to assess the effect of preoperative anaemia on 30-day postoperative morbidity and mortality in patients undergoing major non-cardiac surgery.BACKGROUNDPreoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We aimed to assess the effect of preoperative anaemia on 30-day postoperative morbidity and mortality in patients undergoing major non-cardiac surgery.We analysed data for patients undergoing major non-cardiac surgery in 2008 from The American College of Surgeons' National Surgical Quality Improvement Program database (a prospective validated outcomes registry from 211 hospitals worldwide in 2008). We obtained anonymised data for 30-day mortality and morbidity (cardiac, respiratory, CNS, urinary tract, wound, sepsis, and venous thromboembolism outcomes), demographics, and preoperative and perioperative risk factors. We used multivariate logistic regression to assess the adjusted and modified (nine predefined risk factor subgroups) effect of anaemia, which was defined as mild (haematocrit concentration >29-<39% in men and >29-<36% in women) or moderate-to-severe (≤29% in men and women) on postoperative outcomes.METHODSWe analysed data for patients undergoing major non-cardiac surgery in 2008 from The American College of Surgeons' National Surgical Quality Improvement Program database (a prospective validated outcomes registry from 211 hospitals worldwide in 2008). We obtained anonymised data for 30-day mortality and morbidity (cardiac, respiratory, CNS, urinary tract, wound, sepsis, and venous thromboembolism outcomes), demographics, and preoperative and perioperative risk factors. We used multivariate logistic regression to assess the adjusted and modified (nine predefined risk factor subgroups) effect of anaemia, which was defined as mild (haematocrit concentration >29-<39% in men and >29-<36% in women) or moderate-to-severe (≤29% in men and women) on postoperative outcomes.We obtained data for 227,425 patients, of whom 69,229 (30·44%) had preoperative anaemia. After adjustment, postoperative mortality at 30 days was higher in patients with anaemia than in those without anaemia (odds ratio [OR] 1·42, 95% CI 1·31-1·54); this difference was consistent in mild anaemia (1·41, 1·30-1·53) and moderate-to-severe anaemia (1·44, 1·29-1·60). Composite postoperative morbidity at 30 days was also higher in patients with anaemia than in those without anaemia (adjusted OR 1·35, 1·30-1·40), again consistent in patients with mild anaemia (1·31, 1·26-1·36) and moderate-to-severe anaemia (1·56, 1·47-1·66). When compared with patients without anaemia or a defined risk factor, patients with anaemia and most risk factors had a higher adjusted OR for 30-day mortality and morbidity than did patients with either anaemia or the risk factor alone.FINDINGSWe obtained data for 227,425 patients, of whom 69,229 (30·44%) had preoperative anaemia. After adjustment, postoperative mortality at 30 days was higher in patients with anaemia than in those without anaemia (odds ratio [OR] 1·42, 95% CI 1·31-1·54); this difference was consistent in mild anaemia (1·41, 1·30-1·53) and moderate-to-severe anaemia (1·44, 1·29-1·60). Composite postoperative morbidity at 30 days was also higher in patients with anaemia than in those without anaemia (adjusted OR 1·35, 1·30-1·40), again consistent in patients with mild anaemia (1·31, 1·26-1·36) and moderate-to-severe anaemia (1·56, 1·47-1·66). When compared with patients without anaemia or a defined risk factor, patients with anaemia and most risk factors had a higher adjusted OR for 30-day mortality and morbidity than did patients with either anaemia or the risk factor alone.Preoperative anaemia, even to a mild degree, is independently associated with an increased risk of 30-day morbidity and mortality in patients undergoing major non-cardiac surgery.INTERPRETATIONPreoperative anaemia, even to a mild degree, is independently associated with an increased risk of 30-day morbidity and mortality in patients undergoing major non-cardiac surgery.Vifor Pharma.FUNDINGVifor Pharma.
BACKGROUND: Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We aimed to assess the effect of preoperative anaemia on 30-day postoperative morbidity and mortality in patients undergoing major non-cardiac surgery. METHODS: We analysed data for patients undergoing major non-cardiac surgery in 2008 from The American College of Surgeons' National Surgical Quality Improvement Program database (a prospective validated outcomes registry from 211 hospitals worldwide in 2008). We obtained anonymised data for 30-day mortality and morbidity (cardiac, respiratory, CNS, urinary tract, wound, sepsis, and venous thromboembolism outcomes), demographics, and preoperative and perioperative risk factors. We used multivariate logistic regression to assess the adjusted and modified (nine predefined risk factor subgroups) effect of anaemia, which was defined as mild (haematocrit concentration >29–<39% in men and >29–<36% in women) or moderate-to-severe (≤29% in men and women) on postoperative outcomes. FINDINGS: We obtained data for 227 425 patients, of whom 69 229 (30·44%) had preoperative anaemia. After adjustment, postoperative mortality at 30 days was higher in patients with anaemia than in those without anaemia (odds ratio [OR] 1·42, 95% CI 1·31–1·54); this difference was consistent in mild anaemia (1·41, 1·30–1·53) and moderate-to-severe anaemia (1·44, 1·29–1·60). Composite postoperative morbidity at 30 days was also higher in patients with anaemia than in those without anaemia (adjusted OR 1·35, 1·30–1·40), again consistent in patients with mild anaemia (1·31, 1·26–1·36) and moderate-to-severe anaemia (1·56, 1·47–1·66). When compared with patients without anaemia or a defined risk factor, patients with anaemia and most risk factors had a higher adjusted OR for 30-day mortality and morbidity than did patients with either anaemia or the risk factor alone. INTERPRETATION: Preoperative anaemia, even to a mild degree, is independently associated with an increased risk of 30-day morbidity and mortality in patients undergoing major non-cardiac surgery. FUNDING: Vifor Pharma.
Background: Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We aimed to assess the effect of preoperative anaemia on 30-day postoperative morbidity and mortality in patients undergoing major non-cardiac surgery. Methods: We analysed data for patients undergoing major non-cardiac surgery in 2008 from The American College of Surgeons' National Surgical Quality Improvement Program database (a prospective validated outcomes registry from 211 hospitals worldwide in 2008). We obtained anonymised data for 30-day mortality and morbidity (cardiac, respiratory, CNS, urinary tract, wound, sepsis, and venous thromboembolism outcomes), demographics, and preoperative and perioperative risk factors. We used multivariate logistic regression to assess the adjusted and modified (nine predefined risk factor subgroups) effect of anaemia, which was defined as mild (haematocrit concentration 29-39% in men and 29-36% in women) or moderate-to-severe (29% in men and women) on postoperative outcomes. Findings: We obtained data for 227a pound sterling 25 patients, of whom 69a arrow up 29 (30.44%) had preoperative anaemia. After adjustment, postoperative mortality at 30 days was higher in patients with anaemia than in those without anaemia (odds ratio [OR] 1.42, 95% CI 1.31-1.54); this difference was consistent in mild anaemia (1.41, 1.30-1.53) and moderate-to-severe anaemia (1.44, 1.29-1.60). Composite postoperative morbidity at 30 days was also higher in patients with anaemia than in those without anaemia (adjusted OR 1.35, 1.30-1.40), again consistent in patients with mild anaemia (1.31, 1.26-1.36) and moderate-to-severe anaemia (1.56, 1.47-1.66). When compared with patients without anaemia or a defined risk factor, patients with anaemia and most risk factors had a higher adjusted OR for 30-day mortality and morbidity than did patients with either anaemia or the risk factor alone. Interpretation: Preoperative anaemia, even to a mild degree, is independently associated with an increased risk of 30-day morbidity and mortality in patients undergoing major non-cardiac surgery. Funding: Vifor Pharma.
Summary Background Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We aimed to assess the effect of preoperative anaemia on 30-day postoperative morbidity and mortality in patients undergoing major non-cardiac surgery. Methods We analysed data for patients undergoing major non-cardiac surgery in 2008 from The American College of Surgeons' National Surgical Quality Improvement Program database (a prospective validated outcomes registry from 211 hospitals worldwide in 2008). We obtained anonymised data for 30-day mortality and morbidity (cardiac, respiratory, CNS, urinary tract, wound, sepsis, and venous thromboembolism outcomes), demographics, and preoperative and perioperative risk factors. We used multivariate logistic regression to assess the adjusted and modified (nine predefined risk factor subgroups) effect of anaemia, which was defined as mild (haematocrit concentration >29–<39% in men and >29–<36% in women) or moderate-to-severe (≤29% in men and women) on postoperative outcomes. Findings We obtained data for 227 425 patients, of whom 69 229 (30·44%) had preoperative anaemia. After adjustment, postoperative mortality at 30 days was higher in patients with anaemia than in those without anaemia (odds ratio [OR] 1·42, 95% CI 1·31–1·54); this difference was consistent in mild anaemia (1·41, 1·30–1·53) and moderate-to-severe anaemia (1·44, 1·29–1·60). Composite postoperative morbidity at 30 days was also higher in patients with anaemia than in those without anaemia (adjusted OR 1·35, 1·30–1·40), again consistent in patients with mild anaemia (1·31, 1·26–1·36) and moderate-to-severe anaemia (1·56, 1·47–1·66). When compared with patients without anaemia or a defined risk factor, patients with anaemia and most risk factors had a higher adjusted OR for 30-day mortality and morbidity than did patients with either anaemia or the risk factor alone. Interpretation Preoperative anaemia, even to a mild degree, is independently associated with an increased risk of 30-day morbidity and mortality in patients undergoing major non-cardiac surgery. Funding Vifor Pharma.
Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We aimed to assess the effect of preoperative anaemia on 30-day postoperative morbidity and mortality in patients undergoing major non-cardiac surgery. We analysed data for patients undergoing major non-cardiac surgery in 2008 from The American College of Surgeons' National Surgical Quality Improvement Program database (a prospective validated outcomes registry from 211 hospitals worldwide in 2008). We obtained anonymised data for 30-day mortality and morbidity (cardiac, respiratory, CNS, urinary tract, wound, sepsis, and venous thromboembolism outcomes), demographics, and preoperative and perioperative risk factors. We used multivariate logistic regression to assess the adjusted and modified (nine predefined risk factor subgroups) effect of anaemia, which was defined as mild (haematocrit concentration >29-<39% in men and >29-<36% in women) or moderate-to-severe (≤29% in men and women) on postoperative outcomes. We obtained data for 227 425 patients, of whom 69 229 (30.44%) had preoperative anaemia. After adjustment, postoperative mortality at 30 days was higher in patients with anaemia than in those without anaemia (odds ratio [OR] 1.42, 95% CI 1.31-1.54); this difference was consistent in mild anaemia (1.41, 1.30-1.53) and moderate-to-severe anaemia (1.44, 1.29-1.60). Composite postoperative morbidity at 30 days was also higher in patients with anaemia than in those without anaemia (adjusted OR 1.35, 1.30-1.40), again consistent in patients with mild anaemia (1.31, 1.26-1.36) and moderate-to-severe anaemia (1.56, 1.47-1.66). When compared with patients without anaemia or a defined risk factor, patients with anaemia and most risk factors had a higher adjusted OR for 30-day mortality and morbidity than did patients with either anaemia or the risk factor alone. Preoperative anaemia, even to a mild degree, is independently associated with an increased risk of 30-day morbidity and mortality in patients undergoing major non-cardiac surgery.
Author Jamali, Faek R
Musallam, Khaled M
Sfeir, Pierre M
Habbal, Aida
Hoballah, Jamal J
Tamim, Hani M
Khavandi, Kaivan
Khreiss, Mohammad
Soweid, Assaad
Richards, Toby
Spahn, Donat R
Taher, Ali T
Rosendaal, Frits R
Dahdaleh, Fadi S
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  surname: Musallam
  fullname: Musallam, Khaled M
  organization: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
– sequence: 2
  givenname: Hani M
  surname: Tamim
  fullname: Tamim, Hani M
  organization: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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  givenname: Toby
  surname: Richards
  fullname: Richards, Toby
  organization: Division of Surgery and Interventional Science, University College London Hospital, London, UK
– sequence: 4
  givenname: Donat R
  surname: Spahn
  fullname: Spahn, Donat R
  organization: Institute of Anesthesiology, University Hospital and University of Zurich, Zurich, Switzerland
– sequence: 5
  givenname: Frits R
  surname: Rosendaal
  fullname: Rosendaal, Frits R
  organization: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
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  givenname: Aida
  surname: Habbal
  fullname: Habbal, Aida
  organization: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
– sequence: 7
  givenname: Mohammad
  surname: Khreiss
  fullname: Khreiss, Mohammad
  organization: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
– sequence: 8
  givenname: Fadi S
  surname: Dahdaleh
  fullname: Dahdaleh, Fadi S
  organization: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
– sequence: 9
  givenname: Kaivan
  surname: Khavandi
  fullname: Khavandi, Kaivan
  organization: King's College London British Heart Foundation Centre, The Rayne Institute, St Thomas' Hospital, King's Health Partners AHSC, London, UK
– sequence: 10
  givenname: Pierre M
  surname: Sfeir
  fullname: Sfeir, Pierre M
  organization: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
– sequence: 11
  givenname: Assaad
  surname: Soweid
  fullname: Soweid, Assaad
  organization: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
– sequence: 12
  givenname: Jamal J
  surname: Hoballah
  fullname: Hoballah, Jamal J
  organization: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
– sequence: 13
  givenname: Ali T
  surname: Taher
  fullname: Taher, Ali T
  organization: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
– sequence: 14
  givenname: Faek R
  surname: Jamali
  fullname: Jamali, Faek R
  email: fj03@aub.edu.lb
  organization: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
BackLink http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24604089$$DView record in Pascal Francis
https://www.ncbi.nlm.nih.gov/pubmed/21982521$$D View this record in MEDLINE/PubMed
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Issue 9800
Keywords Medicine
Postoperative
Prognosis
Anemia
Cohort study
Evolution
Hemopathy
Retrospective study
Preoperative
Cardiac surgery
Public health
Language English
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Snippet Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We aimed to...
Summary Background Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well...
BACKGROUND: Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We...
Background: Preoperative anaemia is associated with adverse outcomes after cardiac surgery but outcomes after non-cardiac surgery are not well established. We...
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SubjectTerms Adolescent
Adult
Aged
Aged, 80 and over
anemia
Anemia - blood
Anemia - complications
Anemias. Hemoglobinopathies
Biological and medical sciences
Cohort Studies
composite materials
Data collection
demographic statistics
Diseases of red blood cells
Female
General aspects
Heart attacks
Hematocrit
Hematologic and hematopoietic diseases
Hospitals
Human subjects
Humans
Independent sample
Internal Medicine
Male
Medical personnel
Medical sciences
men
Middle Aged
Morbidity
Mortality
odds ratio
patients
Postoperative Complications - mortality
regression analysis
risk
Risk Factors
Statistical analysis
Studies
surgeons
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Surgical Procedures, Operative
Thromboembolism
urinary tract
Urine
Variables
women
Young Adult
Title Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study
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https://www.clinicalkey.es/playcontent/1-s2.0-S0140673611613810
https://dx.doi.org/10.1016/S0140-6736(11)61381-0
https://www.ncbi.nlm.nih.gov/pubmed/21982521
https://www.proquest.com/docview/900104739
https://www.proquest.com/docview/1678520522
https://www.proquest.com/docview/898840150
https://www.proquest.com/docview/904493580
Volume 378
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