Impact of Preoperative Anaemia and Blood Transfusion on Postoperative Outcomes in Gynaecological Surgery
July
Impact of Preoperative Anaemia and Blood Transfusion on Postoperative Outcomes in Gynaecological Surgery
Funding: The authors received no specific funding for this work. 0 1
Toby Richards 0 1
Khaled M. Musallam 0 1
Joseph Nassif 0 1
Ghina Ghazeeri 0 1
Muhieddine Seoud 0 1
Kurinchi S. Gurusamy 0 1
Faek R. Jamali 0 1
Study Design 0 1
0 1 Division of Surgery and Interventional Science, University College London Hospital , London , United Kingdom , 2 Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon, 3 Department of Obstetrics and Gynaecology, American University of Beirut Medical Centre, Beirut, Lebanon, 4 Department of Surgery, American University of Beirut Medical Centre , Beirut , Lebanon
1 Academic Editor: Halvard Bönig, German Red Cross Blood Service Frankfurt , GERMANY
To evaluate the effect of preoperative anaemia and blood transfusion on 30-day postoperative morbidity and mortality in patients undergoing gynecological surgery. Data were analyzed from 12,836 women undergoing operation in the American College of Surgeons National Surgical Quality Improvement Program. Outcomes measured were; 30day 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.
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Competing Interests: UCL and the research
program led by TR has received research funding
from a variety of sources (19) including government,
charity and industry sources for research into
anaemia, blood transfusion and iron therapy
including, NIHR HTA, Health Foundation, Gideon
Richter, Vifor Pharma Ltd, Pharmocosmos. TR has
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).
also been the invited speaker at over 50 conferences
on anaemia, blood transfusion and iron therapy in the
last 5 years. KMM received consultancy fees and
travel support from Vifor Pharma Ltd. ES received
honoraria from Gideon Richter and Ethicon for
provision of training to healthcare professionals. FRJ
received research funding from Vifor Pharma Ltd.
The remaining authors have no conflicts of interest to
disclose. This does not alter the authors' adherence
to PLOS ONE policies on sharing data and materials.
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.
Preoperative anaemia is an emerging concern in patients undergoing surgery. This has been
also been attributed to the increased need for perioperative transfusions in the anaemic subject
[1–4], which are also independently associated with adverse postoperative outcomes even
when as low as one unit of packed red blood cells (pRBC) is administered intraoperatively [5–
9]. More recently, it has also been established that preoperative anaemia carries an increased
risk of longer hospital stay and increased postoperative morbidity and mortality, irrespective of
the need for transfusion therapy [10–18]. However, available data mostly come from large
retrospective studies reporting overall outcomes for a heterogeneous mix of patients undergoing
general, vascular, or orthopaedic procedures; often with older patients with concomitant
morbidities [12]. Consequently, anaemia may be a marker of the older and more ‘high risk’ patient.
The impact and effect of preoperative anaemia in a more homogenous and younger age group
of patients undergoing surgery, less likely to have comorbidities’ is not known.
A major cause of uterine surgery in reproductive age women is uterine fibroids. Fibroids are
found in up to 70–80% of women and may cause a number of symptoms requiring surgery
[19]. Heavy menstrual bleeding is a common symptom and is probably the most frequent
cause of anaemia in young-otherwise healthy women. Hysterectomy is the most common
operation carried out in women with fibroids, followed by myomectomy, and these are more likely
to be performed in women with symptomatic fibroids [20]. Similarly, anaemia may be a
common complic (...truncated)