Anemia and perioperative mortality in Non-cardiac Surgery patients: a secondary analysis based on a single-center retrospective study

Abstract Background : Evidence regarding the relationship between anemia and perioperative prognosis is controversial. The study was conducted to highlight the specific relationship between anemia and perioperative mortality in non-cardiac surgery patients over 18 years of age. Methods: This study was a retrospective analysis of the electronic medical records of 90,784 patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. Multivariate regression, propensity score analysis, doubly robust estimation, and an inverse probability-weighting model was used to ensure the robustness of our findings. Results : We identified 85,989 patients, of whom75, 163 had none or mild anemia(Hemoglobin>90g/L) and 10,826 had moderate or severe anemia(Hemoglobin≤90g/L). 8,857 patients in each study exposure group had similar propensity scores and were included in the analyses. In the doubly robust model, postoperative 30-day mortality rate was increased by 0.51% (n = 219) in moderate or severe anemia group (Odds Ratio, 1.510; 95% Confidence Interval(CI), 1.049 to 2.174) compared with none or mild anemia group (2.47% vs. 1.22%, P<0.001). Moderate or severe anemia was also associated with increased postoperative blood transfusion rates (OR, 5.608; 95% CI, 4.026 to 7.811, P < 0.001).There was no statistical difference in Intensive Care Unit(ICU) admission rate among different anemia groups within 30 days after surgery (P=0.104). Discussion: In patients undergoing non-cardiac surgery over 18 years old, moderate or severe preoperative anemia would increase the occurrence of postoperative blood transfusion and the risk of death, rather than ICU admission within 30 days after surgery.

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Anemia and perioperative mortality in Non-cardiac Surgery patients: a secondary analysis based on a single-center retrospective study

10.21203/rs.2.22901/v2 ◽

2020 ◽

Author(s):

Xueying Luo ◽

Baoer Liu ◽

Sujing Zheng ◽

Liping Yang ◽

Ya Li ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Severe Anemia ◽

Perioperative Mortality ◽

Icu Admission ◽

Mild Anemia ◽

Postoperative Blood Transfusion ◽

Doubly Robust Estimation ◽

Anemia Group ◽

Doubly Robust

Abstract Introduction: Evidence regarding the relationship between anemia and perioperative prognosis is controversial. The study was conducted to highlight the specific relationship between anemia and perioperative mortality in non-cardiac surgery patients over 18 years of age. Methods: This study was a retrospective analysis of the electronic medical records of 90,784 patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. Multivariate regression, propensity score analysis, doubly robust estimation, and an inverse probability-weighting model was used to ensure the robustness of our findings. Results We identified 85,989 patients, of whom75, 163 had none or mild anemia and 10,826 had moderate or severe anemia. 8,857 patients in each study exposure group had similar propensity scores and were included in the analyses. In the doubly robust model, postoperative 30-day mortality rate was increased by 0.51% (n = 219) in moderate or severe anemia group (odds ratio, 1.510; 95% CI, 1.049 to 2.174) compared with none or mild anemia group (2.47% vs. 1.22%, P<0.001). Moderate or severe anemia was also associated with increased postoperative blood transfusion rates (OR, 5.608; 95% CI, 4.026 to 7.811, P < 0.001).There was no statistical difference in ICU admission rate among different anemia groups within 30 days after surgery (P=0.104). Discussion: In patients undergoing non-cardiac surgery over 18 years old, moderate or severe preoperative anemia would increase the occurrence of postoperative blood transfusion and the risk of death, rather than ICU admission within 30 days after surgery.

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Preoperative anemia and postoperative thirty-day mortality in patients undergoing non-cardiac surgery: a secondary analysis based on a single-center retrospective study.

10.21203/rs.2.22901/v1 ◽

2020 ◽

Author(s):

Xueying Luo ◽

Baoer Liu ◽

Sujing Zheng ◽

Liping Yang ◽

Ya Li ◽

...

Keyword(s):

Cardiac Surgery ◽

Emergency Surgery ◽

Secondary Analysis ◽

Multivariate Logistic Regression Analysis ◽

Effect Sizes ◽

Severe Anemia ◽

Patient Demographics ◽

Mild Anemia ◽

Singapore General Hospital ◽

Different Ages

Abstract Introduction There is controversial and limited evidence to clarify the specific relationship between anemia and perioperative mortality in surgical patients at different ages. We aimed to investigate the relationship between them in patients undergoing non-cardiac surgery of different ages. Methods The present study was a retrospective analysis of the electronic medical records of 90,785 patients who underwent general surgery at the Singapore General Hospital from January 1, 2012 to October 31, 2016. We reanalyzed these data including patient demographics, comorbidities, laboratory results, surgical priority and surgical risk. The main outcome measures included anemia and postoperative 30day mortality. Results The average age of the 86,748 participants enrolled was 52.73 ± 17.24 years old, of which approximately 54.05% were female. 62878 (72.48%)people in the study population had no anemia, 13006 (14.99%) had mild anemia, 10863 (12.52%) had moderate to severe anemia. Multivariate logistic regression analysis showed that anemia was independently associated with postoperative 30day mortality [Compared with none anemia, adjusted odds ratio of mild anemia:1.6404, (95% confidence interval [CI]: 1.2295-2.1886; P =0.000768); and adjusted OR of moderate or severe anemia: 2.6643 (95% [CI]: 2.0315- 3.4941) ;P<0.000001)]. There is no statistical difference among the effect sizes of anemia on 30day mortality, regardless of different age(P=0.2469), gender(p=0.8067), and race (0.4629). And the effect sizes of anemia at each stage on postoperative 30day mortality showed statistically significant increase in intra-transfusion, emergency surgery, high surgery risk(p for interaction is 0.0125,0.0001,0.0032,respectively) Discussion In patients undergoing non-cardiac surgery, anemia is an independent risk factor for perioperative 30day mortality, especially among emergency surgery, high-risk surgery and surgery with intraoperative blood transfusion.

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Cancer Related Anemia in the Era of Erythropoietin Stimulating Agents (ESA)Uncertainty: A Single Cancer Institution Experience.

Blood ◽

10.1182/blood.v114.22.5085.5085 ◽

2009 ◽

Vol 114 (22) ◽

pp. 5085-5085

Author(s):

Hikmat Abdel-Razeq ◽

Shadi B Hijjawi ◽

Hazem Abdulelah ◽

Yousef Ismael ◽

Rula Amarin ◽

...

Keyword(s):

Blood Transfusion ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Combined Treatment ◽

Disease Stage ◽

Severe Anemia ◽

Primary Cancer ◽

Mild Anemia ◽

Erythropoietin Stimulating Agents ◽

Prevalence Of Anemia

Abstract Abstract 5085 Anemia is the most common hematological abnormality in cancer patients. Unfortunately, it is often under-recognized and under-treated. The pathogenesis of cancer anemia is complex and most of the time multifactorial; involving factors related to the tumor itself or its therapy. Recombinant human erythropoietin stimulating agents (ESA) was widely used to prevent and treat cancer and chemotherapy-related anemia. However, many recent studies involving patients with different kind of cancers at different stages of their disease suggested a negative impact on disease progression and survival when such ESA were used to keep Hemoglobin (Hb) at a higher level. The US Food and Drug Administration (FDA) announced revisions and warning to restrict ESA indications. This report describes the prevalence of anemia in cancer patients and its management given the recent confusion and uncertainties. Methods We retrospectively reviewed all consecutive adult cancer patients admitted to regular medical units between Jan and Dec, 2008. Patients admitted to Leukemia, Bone Marrow Transplantation and Intensive Care Units were excluded. Demographic features, reasons for admission, primary cancer diagnosis and disease stage were determined. All patients with Hb value < 12 g/dL at any time during admission were considered anemic. Treatment offered for anemia was also reviewed. Subsequent admissions for the same patients during the study period were also followed up. Results 959 patients (51% males, median age 55 years, range 18- 91) admitted 1862 times were included. Reasons for admission at time of enrollment included chemotherapy (23%), infections including neutropenic fever (20%), palliative and supportive care (15%). Other reasons included pulmonary, neurological, renal and electrolyte imbalances. Primary cancer diagnosis included: Gastrointestinal (21%), Breast (16%), Lymphoma and Multiple Myeloma (16%), and Lung (11%). At time of enrollment, 55% of patients had advanced stage disease. Anemia at any time during admission was detected in 755 (78.7%) patients. Mean Hb value for anemic patients was 9.51 g/dL (range 3.5-11.9, median 9.6). Severe anemia (Hb < 8) was documented in 16.7%, moderate anemia (Hb 8-10) in 41.9% and mild anemia (Hb > 10) in 41.5% of the patients. Majority (69%) of the patients were not offered any treatment for their anemia. Among the total group, blood transfusion was offered for 25%, supplements (including iron, folate and or vitamin B12) for 3.3%. ESA were offered for only 1.1%. Few patients (2.1%) had combined treatment. Mean Hb value at which treatment was started was 8 g/dL, while mean Hb for the patients who were not treated was 10.2 g/dL. Most of the patients (94%) with severe anemia, 32% with the moderate, and 5% of the patients with mild anemia were treated as shown in the table. Conclusions Anemia among adult cancer patients admitted to regular medical units is quiet common. Given the recent FDA warning and the many confusing studies, the prevalence of anemia in cancer patients was found to be high; many of such patients were not offered any treatment. The threshold to start treatment was highly dependent on its severity. Blood transfusion was the most common treatment method. Quality improvement projects should be implemented to better recognize and treat anemia in cancer patients. Disclosures No relevant conflicts of interest to declare.

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Joint effect of pre-operative anemia and perioperative blood transfusion on outcomes of colon-cancer patients undergoing colectomy

Gastroenterology Report ◽

10.1093/gastro/goz033 ◽

2019 ◽

Vol 8 (2) ◽

pp. 151-157 ◽

Cited By ~ 1

Author(s):

Zheng Liu ◽

Jia-Jun Luo ◽

Kevin Y Pei ◽

Sajid A Khan ◽

Xiao-Xu Wang ◽

...

Keyword(s):

Colon Cancer ◽

Blood Transfusion ◽

Cancer Patients ◽

Death Rate ◽

Joint Effect ◽

Severe Anemia ◽

Joint Effects ◽

Mild Anemia ◽

Operative Complications ◽

Perioperative Blood Transfusion

Abstract Background Both pre-operative anemia and perioperative (intra- and/or post-operative) blood transfusion have been reported to increase post-operative complications in patients with colon cancer undergoing colectomy. However, their joint effect has not been investigated. The purpose of this study was to evaluate the joint effect of pre-operative anemia and perioperative blood transfusion on the post-operative outcome of colon-cancer patients after colectomy. Methods We identified patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database 2006–2016 who underwent colectomy for colon cancer. Multivariate logistic regression analysis was employed to assess the independent and joint effects of anemia and blood transfusion on patient outcomes. Results A total of 35,863 patients—18,936 (52.8%) with left-side colon cancer (LCC) and 16,927 (47.2%) with right-side colon cancer (RCC)—were identified. RCC patients were more likely to have mild anemia (62.7%) and severe anemia (2.9%) than LCC patients (40.2% mild anemia and 1.4% severe anemia). A total of 2,661 (7.4%) of all patients (1,079 [5.7%] with LCC and 1,582 [9.3%] with RCC) received a perioperative blood transfusion. Overall, the occurrence rates of complications were comparable between LCC and RCC patients (odds ratio [OR] = 1.01; 95% confidence interval [CI] = 0.95–1.07; P = 0.750). There were significant joint effects of anemia and transfusion on complications and the 30-day death rate (P for interaction: 0.010). Patients without anemia who received a transfusion had a higher risk of any complications (LCC, OR = 3.51; 95% CI = 2.55–4.85; P < 0.001; RCC, OR = 3.74; 95% CI = 2.50–5.59; P < 0.001), minor complications (LCC, OR = 2.54; 95% CI = 1.63–3.97; P < 0.001; RCC, OR = 2.27; 95% CI = 1.24–4.15; P = 0.008), and major complications (LCC, OR = 5.31; 95% CI = 3.68–7.64; P < 0.001; RCC, OR = 5.64; 95% CI = 3.61–8.79; P < 0.001), and had an increased 30-day death rate (LCC, OR = 6.97; 95% CI = 3.07–15.80; P < 0.001; RCC, OR = 4.91; 95% CI = 1.88–12.85; P = 0.001) than patients without anemia who did not receive a transfusion. Conclusions Pre-operative anemia and perioperative transfusion are associated with an increased risk of post-operative complications and increased death rate in colon-cancer patients undergoing colectomy.

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An analysis of the risk factors for perioperative mortality in patients with end-stage renal failure undergoing cardiac surgery: a multicenter study

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2005-861965 ◽

2005 ◽

Vol 53 (S 01) ◽

Author(s):

M Bechtel ◽

T Fischlein ◽

T Krabatsch ◽

H Nägele ◽

B Osswald ◽

...

Keyword(s):

Risk Factors ◽

Renal Failure ◽

Cardiac Surgery ◽

Multicenter Study ◽

Perioperative Mortality ◽

End Stage Renal Failure ◽

End Stage

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Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

Anesthesiology ◽

10.1097/aln.0b013e3182054d06 ◽

2011 ◽

Vol 114 (2) ◽

pp. 283-292 ◽

Cited By ~ 312

Author(s):

Laurent G. Glance ◽

Andrew W. Dick ◽

Dana B. Mukamel ◽

Fergal J. Fleming ◽

Raymond A. Zollo ◽

...

Keyword(s):

Blood Transfusion ◽

Noncardiac Surgery ◽

Pulmonary Complications ◽

Wound Complications ◽

Severe Anemia ◽

Thromboembolic Complications ◽

Mortality And Morbidity ◽

Risk Of Death ◽

Increased Risk ◽

The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

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