Meyer Heidi M, Torborg Alexandra, Cronje Larissa, Thomas Jennifer, Bhettay Anisa, Diedericks Johan, Cilliers Celeste, Kluyts Hyla, Mrara Busisiwe, Kalipa Mandisa, Biccard Bruce
Division of Paediatric Anaesthesia, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Paediatr Anaesth. 2020 Jul;30(7):759-765. doi: 10.1111/pan.13872.
The prevalence of anemia in the South African pediatric surgical population is unknown. Anemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low- and middle-income countries (LMICs).
The primary aim of this study was to describe the association between preoperative anemia and 26 defined postoperative complications, in noncardiac pediatric surgical patients. Secondary aims included describing the prevalence of anemia and risk factors for intraoperative blood transfusion.
This was a secondary analysis of the South African Paediatric Surgical Outcomes Study, a prospective, observational surgical outcomes study. Inclusion criteria were all consecutive patients aged between 6 months and <16 years, presenting to participating centers during the study period who underwent elective and nonelective noncardiac surgery and had a preoperative hemoglobin recorded. Exclusion criteria were patients aged <6 months, undergoing cardiac surgery, or without a preoperative Hb recorded. To determine whether an independent association existed between preoperative anemia and postoperative complications, a hierarchical stepwise logistic regression was conducted.
There were 1094 eligible patients. In children in whom a preoperative Hb was recorded 46.2% had preoperative anemia. Preoperative anemia was independently associated with an increased risk of any postoperative complication (odds ratio 2.0, 95% confidence interval: 1.3-3.1, P = .002). Preoperative anemia (odds ratio 3.6, 95% confidence interval: 1.8-7.1, P < .001) was an independent predictor of intraoperative blood transfusion.
Preoperative anemia had a high prevalence in a LMIC and was associated with increased postoperative complications. The main limitation of our study is the ability to generalize the results to the wider pediatric surgical population, as these findings only relate to children in whom a preoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anemia reduces morbidity and mortality in children undergoing noncardiac surgery.
南非儿科手术人群中贫血的患病率尚不清楚。贫血可能与术后并发症增加有关。我们尚未发现有研究记录低收入和中等收入国家（LMICs）患者的这些发现。
本研究的主要目的是描述非心脏儿科手术患者术前贫血与26种明确的术后并发症之间的关联。次要目的包括描述贫血的患病率以及术中输血的危险因素。
这是对南非儿科手术结局研究的二次分析，该研究是一项前瞻性观察性手术结局研究。纳入标准为在研究期间到参与中心就诊、年龄在6个月至<16岁之间、接受择期和非择期非心脏手术且术前记录了血红蛋白的所有连续患者。排除标准为年龄<6个月、接受心脏手术或未记录术前血红蛋白的患者。为了确定术前贫血与术后并发症之间是否存在独立关联，进行了分层逐步逻辑回归分析。
有1094例符合条件的患者。在记录了术前血红蛋白的儿童中，46.2%有术前贫血。术前贫血与任何术后并发症风险增加独立相关（比值比2.0，95%置信区间：1.3 - 3.1，P = 0.002）。术前贫血（比值比3.6，95%置信区间：1.8 - 7.1，P < 0.001）是术中输血的独立预测因素。
在低收入和中等收入国家，术前贫血患病率较高，且与术后并发症增加有关。我们研究的主要局限性在于无法将结果推广到更广泛的儿科手术人群，因为这些发现仅涉及记录了术前血红蛋白的儿童。需要进行前瞻性研究以确定纠正术前贫血是否能降低接受非心脏手术儿童的发病率和死亡率。
