Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

et al. 2020

BMC Anesthesiol

Background: Evidence regarding the relationship between anemia and perioperative prognosis is controversial. The study was conducted to highlight the specific relationship between anemia and perioperative mortality in noncardiac surgery patients over 18 years of age. Methods: This study was a retrospective analysis of the electronic medical records of 90,784 patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. Multivariate regression, propensity score analysis, doubly robust estimation, and an inverse probability-weighting model was used to ensure the robustness of our findings. Results: We identified 85,989 patients, of whom75, 163 had none or mild anemia (Hemoglobin>90g/L) and 10,826 had moderate or severe anemia (Hemoglobin≤90g/L). 8,857 patients in each study exposure group had similar propensity scores and were included in the analyses. In the doubly robust model, postoperative 30-day mortality rate was increased by 0.51% (n = 219) in moderate or severe anemia group (Odds Ratio, 1.510; 95% Confidence Interval (CI), 1.049 to 2.174) compared with none or mild anemia group (2.47% vs.1.22%, P<0.001). Moderate or severe anemia was also associated with increased postoperative blood transfusion rates (OR, 5.608; 95% CI, 4.026 to 7.811, P < 0.001). There was no statistical difference in Intensive Care Unit (ICU) admission rate among different anemia groups within 30 days after surgery (P=0.104). Discussion: In patients undergoing non-cardiac surgery over 18 years old, moderate or severe preoperative anemia would increase the occurrence of postoperative blood transfusion and the risk of death, rather than ICU admission within 30 days after surgery.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anemia and perioperative mortality in non-cardiac surgery patients: a secondary analysis based on a single-center retrospective study

et al. 2020

BMC Anesthesiol

“…Many reports indicate that although anemia may increase the risk of surgical complications, it has no effect on 30-day mortality. These research groups involved patients undergoing rectal cancer surgery, cardiac surgery [3,13,23,24] , hepatectomy [4] , single-level lumbar surgery [25] . Others objected to the above points, insisting that anemia is an important predictor of 30day mortality, mainly in patients undergoing cardiovascular surgery [5][6][7]12] .…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that the relationship between them is no statistically significant in patients undergoing rectal cancer surgery [2] , cardiac surgery [3] , hepatectomy [4] , single-level lumbar surgery [4] . And conversely, some studies pointing out that anemia is an important predictor of 30day mortality in the patients undergoing, cardiovascular [5][6][7] , spine tumors [8] , major abdominal [9] , joint arthroplasty [10] , gastrointestinal surgery [11] , vascular surgery [12] , and thyroidectomy [13] .…”

Section: Introductionmentioning

confidence: 99%

Anemia and perioperative mortality in Non-cardiac Surgery patients: a secondary analysis based on a single-center retrospective study

et al. 2020

Preprint

Background : Evidence regarding the relationship between anemia and perioperative prognosis is controversial. The study was conducted to highlight the specific relationship between anemia and perioperative mortality in non-cardiac surgery patients over 18 years of age. Methods: This study was a retrospective analysis of the electronic medical records of 90,784 patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. Multivariate regression, propensity score analysis, doubly robust estimation, and an inverse probability-weighting model was used to ensure the robustness of our findings. Results : We identified 85,989 patients, of whom75, 163 had none or mild anemia(Hemoglobin>90g/L) and 10,826 had moderate or severe anemia(Hemoglobin≤90g/L). 8,857 patients in each study exposure group had similar propensity scores and were included in the analyses. In the doubly robust model, postoperative 30-day mortality rate was increased by 0.51% (n = 219) in moderate or severe anemia group (Odds Ratio, 1.510; 95% Confidence Interval(CI), 1.049 to 2.174) compared with none or mild anemia group (2.47% vs. 1.22%, P<0.001). Moderate or severe anemia was also associated with increased postoperative blood transfusion rates (OR, 5.608; 95% CI, 4.026 to 7.811, P < 0.001).There was no statistical difference in Intensive Care Unit(ICU) admission rate among different anemia groups within 30 days after surgery (P=0.104). Discussion: In patients undergoing non-cardiac surgery over 18 years old, moderate or severe preoperative anemia would increase the occurrence of postoperative blood transfusion and the risk of death, rather than ICU admission within 30 days after surgery.

“…However, there is controversy of the relationship between anemia and postoperative 30 day mortality. It has been reported that the relationship between them is no statistically significant in patients undergoing rectal cancer surgery [2], cardiac surgery [3], hepatectomy [4], single-level lumbar surgery [5]. And conversely, some studies pointing out that anemia is an important predictor of postoperative 30 day mortality in the patients undergoing, cardiovascular [6] [7][8], spine tumors [9], major abdominal [10], joint arthroplasty [11], gastrointestinal surgery [12], vascular surgery [13], and thyroidectomy [14].…”

Section: Introductionmentioning

confidence: 99%

Preoperative anemia and postoperative thirty-day mortality in patients undergoing non-cardiac surgery: a secondary analysis based on a single-center retrospective study.

Liu

Zheng

et al. 2020

Preprint

Introduction There is controversial and limited evidence to clarify the specific relationship between anemia and perioperative mortality in surgical patients at different ages. We aimed to investigate the relationship between them in patients undergoing non-cardiac surgery of different ages. Methods The present study was a retrospective analysis of the electronic medical records of 90,785 patients who underwent general surgery at the Singapore General Hospital from January 1, 2012 to October 31, 2016. We reanalyzed these data including patient demographics, comorbidities, laboratory results, surgical priority and surgical risk. The main outcome measures included anemia and postoperative 30day mortality. Results The average age of the 86,748 participants enrolled was 52.73 ± 17.24 years old, of which approximately 54.05% were female. 62878 (72.48%)people in the study population had no anemia, 13006 (14.99%) had mild anemia, 10863 (12.52%) had moderate to severe anemia. Multivariate logistic regression analysis showed that anemia was independently associated with postoperative 30day mortality [Compared with none anemia, adjusted odds ratio of mild anemia:1.6404, (95% confidence interval [CI]: 1.2295-2.1886; P =0.000768); and adjusted OR of moderate or severe anemia: 2.6643 (95% [CI]: 2.0315- 3.4941) ;P<0.000001)]. There is no statistical difference among the effect sizes of anemia on 30day mortality, regardless of different age(P=0.2469), gender(p=0.8067), and race (0.4629). And the effect sizes of anemia at each stage on postoperative 30day mortality showed statistically significant increase in intra-transfusion, emergency surgery, high surgery risk(p for interaction is 0.0125,0.0001,0.0032,respectively) Discussion In patients undergoing non-cardiac surgery, anemia is an independent risk factor for perioperative 30day mortality, especially among emergency surgery, high-risk surgery and surgery with intraoperative blood transfusion.