Royal College of Anaesthetists, London, UK.
Radcliffe Department of Medicine, University of Oxford, UK.
Anaesthesia. 2020 Jul;75(7):904-912. doi: 10.1111/anae.15021. Epub 2020 Apr 21.
Pre-operative anaemia is associated with poor outcomes after elective surgery but its relationship with outcomes after emergency surgery is unclear. We analysed National Emergency Laparotomy Audit data from 1 December 2013 to 30 November 2017, excluding laparotomy for haemorrhage. Anaemia was classified as 'mild' 129-110 g.l-1; 'moderate' 109-80 g.l-1; or 'severe' ≤ 79 g.l-1. The primary outcome was 90-day mortality. Secondary outcomes were 30-day mortality, return to theatre and postoperative hospital stay. The primary outcome was available for 86,763 patients, of whom 45,306 (52%) were anaemic. There were 12,667 (15%) deaths at 90 postoperative days and 9246 (11%) deaths at 30 postoperative days. Anaemia was associated with increased 90-day and 30-day mortality, odds ratio (95%CI): mild, 1.15 (1.09-1.21); moderate, 1.44 (1.36-1.52); and severe, 1.42 (1.24-1.63), p < 0.001 for all; mild, 1.07 (1.00-1.12), p = 0.030; moderate, 1.30 (1.21-1.38), p < 0.001; and severe, 1.22 (1.05-1.43), p = 0.010, respectively. All categories of anaemia were associated with prolonged hospital stay, adjusted coefficient (95%CI): mild, 1.31 (1.01-1.62); moderate, 3.41 (3.04-3.77); severe, 2.80 (1.83-3.77), p < 0.001 for all. Moderate and severe anaemia were associated with increased risk of return to the operating theatre, odds ratio (95%CI): moderate 1.13 (1.06-1.21), p < 0.001; and severe 1.23 (1.06-1.43), p = 0.006. Pre-operative anaemia is common in patients undergoing emergency laparotomy and is associated with increased postoperative mortality and morbidity.
术前贫血与择期手术后的不良结局相关，但与急诊手术后的结局关系尚不清楚。我们分析了 2013 年 12 月 1 日至 2017 年 11 月 30 日期间全国急诊剖腹术审计数据，排除了因出血而行剖腹术的患者。贫血分为“轻度”129-110g.l-1；“中度”109-80g.l-1；或“重度”≤79g.l-1。主要结局为 90 天死亡率。次要结局为 30 天死亡率、重返手术室和术后住院时间。主要结局可用于 86763 例患者，其中 45306 例（52%）存在贫血。术后 90 天有 12667 例（15%）死亡，术后 30 天有 9246 例（11%）死亡。贫血与 90 天和 30 天死亡率增加相关，优势比（95%CI）：轻度，1.15（1.09-1.21）；中度，1.44（1.36-1.52）；重度，1.42（1.24-1.63），所有 p<0.001；轻度，1.07（1.00-1.12），p=0.030；中度，1.30（1.21-1.38），p<0.001；重度，1.22（1.05-1.43），p=0.010。所有贫血类别均与住院时间延长相关，调整后的系数（95%CI）：轻度，1.31（1.01-1.62）；中度，3.41（3.04-3.77）；重度，2.80（1.83-3.77），所有 p<0.001。中度和重度贫血与重返手术室的风险增加相关，优势比（95%CI）：中度，1.13（1.06-1.21），p<0.001；重度，1.23（1.06-1.43），p=0.006。术前贫血在接受急诊剖腹术的患者中很常见，与术后死亡率和发病率增加相关。
