Beattie W Scott, Karkouti Keyvan, Wijeysundera Duminda N, Tait Gordon
Department of Anesthesia, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.
Anesthesiology. 2009 Mar;110(3):574-81. doi: 10.1097/ALN.0b013e31819878d3.
Preoperative anemia is an important risk factor for perioperative red blood cell transfusions and has been shown to be independently associated with adverse outcomes after noncardiac surgery. The objective of this observational study was to measure the prevalence of preoperative anemia and assess the relationship between preoperative anemia and postoperative mortality.
Data were retrospectively collected on 7,759 consecutive noncardiac surgical patients at the University Health Network between 2003 and 2006. Preoperative anemia was defined as a hemoglobin concentration less than 12.0 g/dl for women and less than 13.0 g/dl for men. The unadjusted and adjusted relationship between preoperative anemia and mortality was assessed using logistic regression and propensity analyses.
Preoperative anemia was common and equal between genders (39.5% for men and 39.9% for women) and was associated with a nearly five-fold increase in the odds of postoperative mortality. After adjustment for major confounders using logistic regression, anemia was still associated with increased mortality (odds ratio, 2.36; 95% confidence interval, 1.57-3.41). This relationship was unchanged after elimination of patients with severe anemia and patients who received transfusions. In a propensity-matched cohort of patients, anemia was associated with increased mortality (odds ratio, 2.29; 95% confidence interval, 1.45-3.63).
Anemia is a common condition in surgical patients and is independently associated with increased mortality. Although anemia increases mortality independent of transfusion, it is associated with increased requirement for transfusion, which is also associated with increased mortality. Treatment of preoperative anemia should be the focus of investigations for the reduction of perioperative risk.
术前贫血是围手术期红细胞输血的重要危险因素，并且已被证明与非心脏手术后的不良结局独立相关。这项观察性研究的目的是测量术前贫血的患病率，并评估术前贫血与术后死亡率之间的关系。
回顾性收集了2003年至2006年期间在大学健康网络连续接受非心脏手术的7759例患者的数据。术前贫血定义为女性血红蛋白浓度低于12.0 g/dl，男性低于13.0 g/dl。使用逻辑回归和倾向分析评估术前贫血与死亡率之间的未调整和调整后的关系。
术前贫血很常见，且男女患病率相当（男性为39.5%，女性为39.9%），并且与术后死亡几率增加近五倍相关。在使用逻辑回归对主要混杂因素进行调整后，贫血仍与死亡率增加相关（比值比，2.36；95%置信区间，1.57 - 3.41）。在排除严重贫血患者和接受输血的患者后，这种关系没有改变。在倾向匹配的患者队列中，贫血与死亡率增加相关（比值比，2.29；95%置信区间，1.45 - 3.63）。
贫血在外科手术患者中是一种常见情况，并且与死亡率增加独立相关。虽然贫血增加死亡率与输血无关，但它与输血需求增加相关，而输血需求增加也与死亡率增加相关。术前贫血的治疗应成为降低围手术期风险研究的重点。
