The effects of preoperative moderate to severe anaemia on length of hospital stay: A propensity score-matched analysis in non-cardiac surgery patients

Carolien S E Bulte; Christa Boer; Sabrine N T Hemmes; Ary Serpa Neto; Jan M Binnekade; Goran Hedenstierna; Samir Jaber; Michael Hiesmayr; Markus W Hollmann; Gary H Mills; Marcos F Vidal Melo; Rupert M Pearse; Christian Putensen; Werner Schmid; Paolo Severgnini; Hermann Wrigge; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J Schultz; for the LAS VEGAS; study–investigators; the PROVE Network; and the Clinical Trial Network of the European Society of Anaesthesiology

doi:10.1097/EJA.0000000000001412

The effects of preoperative moderate to severe anaemia on length of hospital stay: A propensity score-matched analysis in non-cardiac surgery patients

Eur J Anaesthesiol. 2021 Jun 1;38(6):571-581. doi: 10.1097/EJA.0000000000001412.

Affiliation

¹ From the Department of Anaesthesiology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands (CSE-B, CB), Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesia (L·E·I·C·A), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands (SNT-H, AS-N, JM-B, MJS), Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands (SNT-H, MW-H), Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paolo, Brazil (AS-N), Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (GH), Montpellier University Hospital, Saint Eloi Intensive Care Unit and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France (SJ), Division of Cardiac, Thoracic, Vascular Anaesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria (MH, WS), Operating Services, Critical Care and Anaesthesia, Sheffield Teaching Hospitals, Sheffield and University of Sheffield, Sheffield, UK (GH-M), Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Bostan, MA, USA (MF-VM), Queen Mary University of London, London, UK (RM-P), Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany (CP), Department of Biotechnology and Sciences of Life, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (PS), Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany (HW), Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (MGD-A), Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genova, Italy (PP), IRCCS Ospedale Policlinico San Martino, Genova, Italy (PP), Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand (MJS), Nuffield Department of Medicine, University of Oxford, Oxford, UK (MJS).

Abstract

Background: Anaemia is frequently recorded during preoperative screening and has been suggested to affect outcomes after surgery negatively.

Objectives: The objectives were to assess the frequency of moderate to severe anaemia and its association with length of hospital stay.

Design: Post hoc analysis of the international observational prospective 'Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study.

Patients and setting: The current analysis included adult patients requiring general anaesthesia for non-cardiac surgery. Preoperative anaemia was defined as a haemoglobin concentration of 11 g dl-1 or lower, thus including moderate and severe anaemia according to World Health Organisation criteria.

Main outcome measures: The primary outcome was length of hospital stay. Secondary outcomes included hospital mortality, intra-operative adverse events and postoperative pulmonary complications (PPCs).

Results: Haemoglobin concentrations were available for 8264 of 9864 patients. Preoperative moderate to severe anaemia was present in 7.7% of patients. Multivariable analysis showed that preoperative moderate to severe anaemia was associated with an increased length of hospital stay with a mean difference of 1.3 ((95% CI 0.8 to 1.8) days; P < .001). In the propensity-matched analysis, this association remained present, median 4.0 [IQR 1.0 to 5.0] vs. 2.0 [IQR 0.0 to 5.0] days, P = .001. Multivariable analysis showed an increased in-hospital mortality (OR 2.9 (95% CI 1.1 to 7.5); P = .029), and higher incidences of intra-operative hypotension (36.3 vs. 25.3%; P < .001) and PPCs (17.1 vs. 10.5%; P = .001) in moderately to severely anaemic patients. However, this was not confirmed in the propensity score-matched analysis.

Conclusions: In this international cohort of non-cardiac surgical patients, preoperative moderate to severe anaemia was associated with a longer duration of hospital stay but not increased intra-operative complications, PPCs or in-hospital mortality.

Trial registration: The LAS VEGAS study was registered at Clinicaltrials.gov, NCT01601223.

Publication types

Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anemia* / diagnosis
Anemia* / epidemiology
Humans
Length of Stay
Postoperative Complications / diagnosis
Postoperative Complications / epidemiology
Propensity Score
Prospective Studies

Associated data

ClinicalTrials.gov/NCT01601223

Grants and funding

UH3 HL140177/HL/NHLBI NIH HHS/United States