Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK.
Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK; Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK.
Br J Anaesth. 2018 Dec;121(6):1227-1235. doi: 10.1016/j.bja.2018.08.026. Epub 2018 Oct 25.
Anaemia is associated with poor postoperative outcomes, but few studies have described the impact of preoperative anaemia in low- and middle- (LMICs), and high-income countries (HICs).
This was a planned analysis of data collected during an international 7 day cohort study of adults undergoing elective inpatient surgery. The primary outcome was in-hospital death, and the secondary outcomes were in-hospital complications. Anaemia was defined as haemoglobin <12 g dl for females and <13 g dl for males. Hierarchical three-level mixed-effect logistic regression models were constructed to examine the associations between preoperative anaemia and outcomes.
We included 38 770 patients from 474 hospitals in 27 countries of whom 11 675 (30.1%) were anaemic. Of these, 6886 (17.8%) patients suffered a complication and 198 (0.5%) died. Patients from LMICs were younger with lower ASA physical status scores, but a similar prevalence of anaemia [LMIC: 5072 (32.5%) of 15 585 vs HIC: 6603 (28.5%) of 23 185]. Patients with moderate [odds ratio (OR): 2.70; 95% confidence interval (CI): 1.88-3.87] and severe anaemia (OR: 4.09; 95% CI: 1.90-8.81) were at an increased risk of death in both HIC and LMICs. Complication rates increased with the severity of anaemia. Compared with patients in LMICs, those in HICs experienced fewer complications after an interaction term analysis [LMIC (OR: 0.92; 95% CI: 0.87-0.97) vs HIC (OR: 0.86; 95% CI: 0.84-0.87); P<0.01].
One-third of patients undergoing elective surgery are anaemic. These patients have an increased risk of complications and death. The prevalence of anaemia is similar amongst patients in LMICs despite their younger age and lower risk profile.
ISRCTN51817007.
贫血与术后不良结局相关，但很少有研究描述术前贫血对中低收入国家（LMICs）和高收入国家（HICs）的影响。
这是一项针对在国际 7 天择期住院手术成年患者队列研究中收集的数据的计划分析。主要结局是院内死亡，次要结局是院内并发症。贫血定义为女性血红蛋白<12g/dl 和男性血红蛋白<13g/dl。构建了分层三水平混合效应逻辑回归模型，以检验术前贫血与结局之间的关系。
我们纳入了来自 27 个国家的 474 家医院的 38770 名患者，其中 11675 名（30.1%）贫血。这些患者中，6886 名（17.8%）发生并发症，198 名（0.5%）死亡。来自 LMICs 的患者年龄较小，ASA 身体状况评分较低，但贫血患病率相似[LMIC：15585 名患者中有 5072 名（32.5%），HIC：23185 名患者中有 6603 名（28.5%）]。中重度贫血患者（OR：2.70；95%CI：1.88-3.87）和严重贫血患者（OR：4.09；95%CI：1.90-8.81）在 HIC 和 LMIC 中死亡风险均增加。随着贫血程度的加重，并发症发生率也随之增加。与 LMIC 患者相比，HIC 患者在交互项分析后并发症发生率较低[LMIC（OR：0.92；95%CI：0.87-0.97）与 HIC（OR：0.86；95%CI：0.84-0.87）；P<0.01]。
三分之一的择期手术患者贫血。这些患者有更高的并发症和死亡风险。尽管年龄较小且风险较低，LMIC 患者的贫血患病率与 HIC 患者相似。
ISRCTN51817007。
