Yong Phui S Au, Ke Yuhe, Kok Eunice J Y, Tan Brenda P Y, Kadir Hanis Abdul, Abdullah Hairil R
Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
Can J Anaesth. 2024 Mar;71(3):353-366. doi: 10.1007/s12630-023-02676-z. Epub 2024 Jan 5.
Preoperative anemia is associated with poor postoperative outcomes. Older patients have limited physiologic reserves, which renders them vulnerable to the stress of major abdominal surgery. We aimed to determine if the severity of preoperative anemia is associated with early postoperative morbidity among older patients undergoing major abdominal surgery.
Ethics approval was obtained from SingHealth Centralized Institutional Review Board. This is a prospective observational study conducted in the preoperative anesthesia clinic of a tertiary Singapore hospital from 2017 to 2021. Patient demographic data, comorbidities, and intraoperative details were collected. Outcome measures included blood transfusions, complications according to the Postoperative Morbidity Survey, days alive and out of hospital (DaOH), length of hospital stay, and mortality.
A total of 469 patients were analyzed, 37.5% of whom had preoperative anemia (serum hemoglobin of < 13 g·dL in males and < 12 g·dL in females). Anemia was significantly associated with older age, a higher age-adjusted Comprehensive Complication Index score, a higher incidence of diabetes mellitus, and a higher proportion of patients with an American Society of Anesthesiologists Physical Status of III or IV. The severity of anemia was associated with the presence of early postoperative morbidity at day 5, increased blood transfusions, longer length of hospital stay, and fewer DaOH at 30 days and six months.
Anemia is significantly associated with poorer postoperative outcomes in the older population. The impact of anemia on postoperative outcomes could be further evaluated with quality of life indicators, patient-reported outcome measures, and health economic tools.
术前贫血与术后不良结局相关。老年患者的生理储备有限，这使他们易受腹部大手术应激的影响。我们旨在确定术前贫血的严重程度是否与接受腹部大手术的老年患者术后早期发病率相关。
获得新加坡健康集团中央机构审查委员会的伦理批准。这是一项前瞻性观察性研究，于2017年至2021年在新加坡一家三级医院的术前麻醉诊所进行。收集患者的人口统计学数据、合并症和术中细节。结局指标包括输血情况、根据术后发病率调查的并发症、存活且出院天数（DaOH）、住院时间和死亡率。
共分析了469例患者，其中37.5%有术前贫血（男性血清血红蛋白<13 g·dL，女性<12 g·dL）。贫血与老年、年龄调整后的综合并发症指数评分较高、糖尿病发病率较高以及美国麻醉医师协会身体状况为III或IV级的患者比例较高显著相关。贫血的严重程度与术后第5天早期发病率的存在、输血增加、住院时间延长以及30天和6个月时较少的DaOH相关。
贫血与老年人群较差的术后结局显著相关。贫血对术后结局的影响可以通过生活质量指标、患者报告的结局测量和健康经济工具进一步评估。
