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Impact of Preoperative Anaemia and Blood Transfusion on Postoperative Outcomes in Gynaecological Surgery.

Richards T, Musallam KM, Nassif J, Ghazeeri G, Seoud M, Gurusamy KS, Jamali FR - PLoS ONE (2015)

Bottom Line: Adjusted for confounders by multivariate logistic regression; preoperative anaemia was independently and significantly associated with increased odds of 30-day mortality (OR: 2.40, 95%CI: 1.06-5.44) and composite morbidity (OR: 1.80, 95%CI: 1.45-2.24).This was reflected by significantly higher adjusted odds of almost all specific morbidities including; respiratory, central nervous system, renal, wound, sepsis, and venous thrombosis.Preoperative anaemia is associated with adverse post-operative outcomes in women undergoing gynecological surgery.

View Article: PubMed Central - PubMed

Affiliation: Division of Surgery and Interventional Science, University College London Hospital, London, United Kingdom.

ABSTRACT

Objective: To evaluate the effect of preoperative anaemia and blood transfusion on 30-day postoperative morbidity and mortality in patients undergoing gynecological surgery.

Study design: Data were analyzed from 12,836 women undergoing operation in the American College of Surgeons National Surgical Quality Improvement Program. Outcomes measured were; 30-day postoperative mortality, composite and specific morbidities (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thrombosis, or major bleeding). Multivariate logistic regression models were performed using adjusted odds ratios (ORadj) to assess the independent effects of preoperative anaemia (hematocrit <36.0%) on outcomes, effect estimates were performed before and after adjustment for perioperative transfusion requirement.

Results: The prevalence of preoperative anaemia was 23.9% (95%CI: 23.2-24.7). Adjusted for confounders by multivariate logistic regression; preoperative anaemia was independently and significantly associated with increased odds of 30-day mortality (OR: 2.40, 95%CI: 1.06-5.44) and composite morbidity (OR: 1.80, 95%CI: 1.45-2.24). This was reflected by significantly higher adjusted odds of almost all specific morbidities including; respiratory, central nervous system, renal, wound, sepsis, and venous thrombosis. Blood Transfusion increased the effect of preoperative anaemia on outcomes (61% of the effect on mortality and 16% of the composite morbidity).

Conclusions: Preoperative anaemia is associated with adverse post-operative outcomes in women undergoing gynecological surgery. This risk associated with preoperative anaemia did not appear to be corrected by use of perioperative transfusion.

No MeSH data available.


Related in: MedlinePlus

Crude 30-day postoperative mortality and morbidity rates in patients with and without preoperative anaemia.CNS, central nervous system.
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pone.0130861.g001: Crude 30-day postoperative mortality and morbidity rates in patients with and without preoperative anaemia.CNS, central nervous system.

Mentions: Overall patients with preoperative anaemia had a significantly higher crude 30-day mortality (0.5% vs. 0.1%, p<0.001) and composite morbidity (5.1% vs. 2.5%, p<0.001) rates than patients without preoperative anaemia (Fig 1). Preoperative anaemia was associated with significantly higher rates of most evaluated 30-day postoperative outcomes (Fig 1). Preoperative anaemia was associated with significantly higher rates probability of 30-day mortality and composite morbidity. These probabilities continued to increase with declining HCT levels in the preoperative anaemia group (Fig 2). After multivariate analysis adjusting for potential confounders, preoperative anaemia remained independently and significantly associated with increased 30-day mortality and morbidity (Table 2). The ORadj-2 for death was 2.40 (95% CI: 1.06–5.44) in patients with preoperative anaemia compared to patients without. The ORadj-2 for composite morbidity was 1.80 (95% CI: 1.45–2.24) in patients with preoperative anaemia compared to patients without. This was reflected by significantly higher adjusted odds of almost all specific morbidities including respiratory, CNS, renal, wound, sepsis, and venous thrombosis (Table 2). Although the adjusted odds of cardiac occurrences and major bleeding were higher in patients with preoperative anaemia compared to patients without, they had high uncertainty.


Impact of Preoperative Anaemia and Blood Transfusion on Postoperative Outcomes in Gynaecological Surgery.

Richards T, Musallam KM, Nassif J, Ghazeeri G, Seoud M, Gurusamy KS, Jamali FR - PLoS ONE (2015)

Crude 30-day postoperative mortality and morbidity rates in patients with and without preoperative anaemia.CNS, central nervous system.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492675&req=5

pone.0130861.g001: Crude 30-day postoperative mortality and morbidity rates in patients with and without preoperative anaemia.CNS, central nervous system.
Mentions: Overall patients with preoperative anaemia had a significantly higher crude 30-day mortality (0.5% vs. 0.1%, p<0.001) and composite morbidity (5.1% vs. 2.5%, p<0.001) rates than patients without preoperative anaemia (Fig 1). Preoperative anaemia was associated with significantly higher rates of most evaluated 30-day postoperative outcomes (Fig 1). Preoperative anaemia was associated with significantly higher rates probability of 30-day mortality and composite morbidity. These probabilities continued to increase with declining HCT levels in the preoperative anaemia group (Fig 2). After multivariate analysis adjusting for potential confounders, preoperative anaemia remained independently and significantly associated with increased 30-day mortality and morbidity (Table 2). The ORadj-2 for death was 2.40 (95% CI: 1.06–5.44) in patients with preoperative anaemia compared to patients without. The ORadj-2 for composite morbidity was 1.80 (95% CI: 1.45–2.24) in patients with preoperative anaemia compared to patients without. This was reflected by significantly higher adjusted odds of almost all specific morbidities including respiratory, CNS, renal, wound, sepsis, and venous thrombosis (Table 2). Although the adjusted odds of cardiac occurrences and major bleeding were higher in patients with preoperative anaemia compared to patients without, they had high uncertainty.

Bottom Line: Adjusted for confounders by multivariate logistic regression; preoperative anaemia was independently and significantly associated with increased odds of 30-day mortality (OR: 2.40, 95%CI: 1.06-5.44) and composite morbidity (OR: 1.80, 95%CI: 1.45-2.24).This was reflected by significantly higher adjusted odds of almost all specific morbidities including; respiratory, central nervous system, renal, wound, sepsis, and venous thrombosis.Preoperative anaemia is associated with adverse post-operative outcomes in women undergoing gynecological surgery.

View Article: PubMed Central - PubMed

Affiliation: Division of Surgery and Interventional Science, University College London Hospital, London, United Kingdom.

ABSTRACT

Objective: To evaluate the effect of preoperative anaemia and blood transfusion on 30-day postoperative morbidity and mortality in patients undergoing gynecological surgery.

Study design: Data were analyzed from 12,836 women undergoing operation in the American College of Surgeons National Surgical Quality Improvement Program. Outcomes measured were; 30-day postoperative mortality, composite and specific morbidities (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thrombosis, or major bleeding). Multivariate logistic regression models were performed using adjusted odds ratios (ORadj) to assess the independent effects of preoperative anaemia (hematocrit <36.0%) on outcomes, effect estimates were performed before and after adjustment for perioperative transfusion requirement.

Results: The prevalence of preoperative anaemia was 23.9% (95%CI: 23.2-24.7). Adjusted for confounders by multivariate logistic regression; preoperative anaemia was independently and significantly associated with increased odds of 30-day mortality (OR: 2.40, 95%CI: 1.06-5.44) and composite morbidity (OR: 1.80, 95%CI: 1.45-2.24). This was reflected by significantly higher adjusted odds of almost all specific morbidities including; respiratory, central nervous system, renal, wound, sepsis, and venous thrombosis. Blood Transfusion increased the effect of preoperative anaemia on outcomes (61% of the effect on mortality and 16% of the composite morbidity).

Conclusions: Preoperative anaemia is associated with adverse post-operative outcomes in women undergoing gynecological surgery. This risk associated with preoperative anaemia did not appear to be corrected by use of perioperative transfusion.

No MeSH data available.


Related in: MedlinePlus