Findings of a study published in an article Online First revealed that patients with anemia who are undergoing a range of non-cardiac surgical procedures have a 42% higher risk of death and a 35% higher risk of serious co-morbidities compared with non-anemic patients. The study, which will also be published in the upcoming Surgery Special Issue of The Lancet was conducted by Dr Khaled M Musallam and Dr Faek R Jamali of the American University of Beirut Medical Center in Beirut, Lebanon, and their team.
Researchers know that preoperative anemia is linked to adverse outcomes following cardiac surgery, however, so far little is known about outcomes after non-cardiac surgery.
The researchers therefore decided to examine the effect of pre-operative anemia on 30-day postoperative morbidity and mortality in patients undergoing major non-cardiac surgery by assessing 227,425 patients of which 69,229 (30%) had preoperative anemia. They obtained a large set of data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) that included post-operative outcomes of death and major morbidities, such as cardiac, respiratory, urinary tract, CNS, sepsis, wound and venous thromboembolism. The data also showed demographic and preoperative and perioperative risk factors. The researchers included the following types of general surgery in their study: gynecological, neurosurgical, otolaryngological, orthopedic, plastic, urological, vascular and thoracic surgery.
Findings revealed postoperative mortality at 30 days to be 42% higher in patients with anemia compared with those without anemia. The increased risk was categorized into patients suffering from mild anemia (41%) and those with moderate to severe anemia (44%).
The researchers established that anemic patients also had a 35% higher chance of developing postoperative morbidities, such as cardiac, urinary respiratory, wound, sepsis and thromboembolic problems compared with those patients with no anemia. For those suffering from mild anemia the increased risk was 31% with a 56% increased risk for moderate to severe anemic patients.
After the researchers adjusted their findings by risk factors, including patients aged 65 years or older, cardiac disease, CNS disease, renal disease, severe chronic obstructive pulmonary disease, cancer or systemic sepsis, they compared anemic patients together and most risk factors against those without anemia or a defined risk factor. They established that those suffering from anemia and most risk factors had a higher risk for 30-day mortality and morbidity than patients with either anemia or the risk factor.
In a concluding statement the authors say:
“Because even mild anemia increases the risk of postoperative morbidity and mortality in patients undergoing major non-cardiac surgery, doctors need to consider preoperative treatment of anemia when possible. Further research is needed to establish the efficacy, safety, and cost-effectiveness of such preoperative anemia management.”
Professor Hans Gombotz from the Department of Anesthesiology and Intensive Care at the General Hospital in Linz, Austria stated in a linked comment that in some patients, risks are linked to anemia treatments, such as iron supplementation or stimulation of red blood cell production (erythropoeisis) but he continues, “The study strongly indicates that the implementation of treatment of anemia as part of a universal patient blood management should become standard of care in patients undergoing elective surgical procedures, particularly in those where substantial blood loss is to be expected. However, additional studies are urgently needed to secure the efficacy and safety of preoperative treatment of anemia.”
Written by Petra Rattue