Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Pediatr. 2016 Sep 1;170(9):855-62. doi: 10.1001/jamapediatrics.2016.1032.
Neonates undergoing noncardiac surgery are at risk for adverse outcomes. Preoperative anemia is a strong independent risk factor for postoperative mortality in adults. To our knowledge, this association has not been investigated in the neonatal population.
To assess the association between preoperative anemia and postoperative mortality in neonates undergoing noncardiac surgery in a large sample of US hospitals.
DESIGN, SETTING, AND PARTICIPANTS: Using data from the 2012 and 2013 pediatric databases of the American College of Surgeons National Surgical Quality Improvement Program, we conducted a retrospective study of neonates undergoing noncardiac surgery. Analysis of the data took place between June 2015 and December 2015. All neonates (0-30 days old) with a recorded preoperative hematocrit value were included.
Anemia defined as hematocrit level of less than 40%.
Receiver operating characteristics analysis was used to assess the association between preoperative hematocrit and mortality, and the Youden J Index was used to determine the specific hematocrit cutoff point to define anemia in the neonatal population. Demographic and postoperative outcomes variables were compared between anemic and nonanemic neonates. Univariate and multivariable logistic regression analyses were used to determine factors associated with postoperative neonatal mortality. An external validation was performed using the 2014 American College of Surgeons National Surgical Quality Improvement Program database.
Neonates accounted for 2764 children (6%) in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program databases. Neonates inlcuded in the study were predominately male (64.5%), white (66.3%), and term (69.9% greater than 36 weeks' gestation) and weighed more than 2 kg (85.0%). Postoperative in-hospital mortality was 3.4% in neonates and 0.6% in all age groups (0-18 years). A preoperative hematocrit level of less than 40% was the optimal cutoff (Youden) to predict in-hospital mortality. Multivariable regression analysis demonstrated that preoperative anemia is an independent risk factor for mortality (OR, 2.62; 95% CI, 1.51-4.57) in neonates. The prevalence of postoperative in-hospital mortality was significantly higher in neonates with a preoperative hematocrit level less than 40%; being 7.5% (95% CI, 1%-10%) vs 1.4% (95% CI, 0%-4%) for preoperative hematocrit levels 40%, or greater. The relationship between anemia and in-hospital mortality was confirmed in our validation cohort (National Surgical Quality Improvement Program 2014).
To our knowledge, this is the first study to define the incidence of preoperative anemia in neonates, the incidence of postoperative in-hospital mortality in neonates, and the association between preoperative anemia and postoperative mortality in US hospitals. Timely diagnosis, prevention, and appropriate treatment of preoperative anemia in neonates might improve survival.
接受非心脏手术的新生儿存在不良结局的风险。术前贫血是成人术后死亡率的一个强有力的独立危险因素。据我们所知，这一关联在新生儿人群中尚未得到研究。
评估在美国多家医院的大量新生儿非心脏手术患者中，术前贫血与术后死亡率之间的关系。
设计、地点和参与者：利用美国外科医师学会国家外科质量改进计划 2012 年和 2013 年儿科数据库的数据，我们对接受非心脏手术的新生儿进行了回顾性研究。数据分析于 2015 年 6 月至 2015 年 12 月进行。所有接受过记录术前血球压积值的新生儿（0-30 天）都包括在内。
贫血定义为血球压积水平低于 40%。
采用受试者工作特征分析评估术前血球压积与死亡率之间的关系，采用 Youden J 指数确定特定的血球压积切点来定义新生儿人群中的贫血。对贫血和非贫血新生儿的人口统计学和术后结局变量进行比较。采用单变量和多变量逻辑回归分析确定与新生儿术后死亡率相关的因素。使用美国外科医师学会国家外科质量改进计划 2014 年数据库进行外部验证。
2012-2013 年美国外科医师学会国家外科质量改进计划数据库中，新生儿占 2764 例（6%）。纳入研究的新生儿主要为男性（64.5%）、白人（66.3%）、足月（69.9%大于 36 周妊娠）和体重超过 2 公斤（85.0%）。新生儿的术后院内死亡率为 3.4%，所有年龄组（0-18 岁）的死亡率为 0.6%。术前血球压积水平低于 40%是预测院内死亡率的最佳截断值（Youden）。多变量回归分析显示，术前贫血是新生儿死亡的独立危险因素（OR，2.62；95%CI，1.51-4.57）。术前血球压积水平低于 40%的新生儿术后院内死亡率明显更高；术前血球压积水平为 40%或更高的患儿为 7.5%（95%CI，1%-10%），而术前血球压积水平为 40%的患儿为 1.4%（95%CI，0%-4%）。贫血与院内死亡率之间的关系在我们的验证队列中得到了证实（2014 年美国外科医师学会国家外科质量改进计划）。
据我们所知，这是第一项在美国医院中定义新生儿术前贫血发生率、新生儿术后院内死亡率发生率以及术前贫血与术后死亡率之间关系的研究。及时诊断、预防和适当治疗新生儿术前贫血可能会提高生存率。
