Impact of Preoperative Anaemia and Blood Transfusion on Postoperative Outcomes in Gynaecological Surgery

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2015 Jul 7

PMID 26147954

Citations 36

Authors

Toby Richards

Khaled M Musallam

Joseph Nassif

Ghina Ghazeeri

Muhieddine Seoud

Kurinchi S Gurusamy

Faek R Jamali

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the effect of preoperative anaemia and blood transfusion on 30-day postoperative morbidity and mortality in patients undergoing gynecological surgery.

Study Design: Data were analyzed from 12,836 women undergoing operation in the American College of Surgeons National Surgical Quality Improvement Program. Outcomes measured were; 30-day postoperative mortality, composite and specific morbidities (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thrombosis, or major bleeding). Multivariate logistic regression models were performed using adjusted odds ratios (ORadj) to assess the independent effects of preoperative anaemia (hematocrit <36.0%) on outcomes, effect estimates were performed before and after adjustment for perioperative transfusion requirement.

Results: The prevalence of preoperative anaemia was 23.9% (95%CI: 23.2-24.7). Adjusted for confounders by multivariate logistic regression; preoperative anaemia was independently and significantly associated with increased odds of 30-day mortality (OR: 2.40, 95%CI: 1.06-5.44) and composite morbidity (OR: 1.80, 95%CI: 1.45-2.24). This was reflected by significantly higher adjusted odds of almost all specific morbidities including; respiratory, central nervous system, renal, wound, sepsis, and venous thrombosis. Blood Transfusion increased the effect of preoperative anaemia on outcomes (61% of the effect on mortality and 16% of the composite morbidity).

Conclusions: Preoperative anaemia is associated with adverse post-operative outcomes in women undergoing gynecological surgery. This risk associated with preoperative anaemia did not appear to be corrected by use of perioperative transfusion.

Citing Articles

Preoperative ANemiA among elderly undergoing Major Abdominal surgery (PANAMA) is associated with early postoperative morbidity and worse quality of life outcomes.

Abdullah H, Loh C, Kok E, Tan B, Kadir H, Au-Yong P Sci Rep. 2025; 15(1):4239.

PMID: 39905083 PMC: 11794605. DOI: 10.1038/s41598-025-85898-z.

The association between preoperative anemia and postoperative mortality among non-cardiac surgical patients in Northwest Ethiopia: a prospective cohort study.

Molla M, Endeshaw A, Asfaw G, Kumie F BMC Anesthesiol. 2025; 25(1):19.

PMID: 39789460 PMC: 11715528. DOI: 10.1186/s12871-025-02900-x.

Magnitude and associated factors of preoperative anemia among adult elective surgical patients at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, 2024.

Biset W, Nasser N, Tolu L, Tsega N, Abraha M Front Med (Lausanne). 2024; 11:1466554.

PMID: 39736969 PMC: 11683085. DOI: 10.3389/fmed.2024.1466554.

European Society for Gynaecological Endoscopy (ESGE) Good Practice Recommendations on surgical techniques for removal of fibroids: part 1 abdominal (laparoscopic and open) myomectomy.

Saridogan E, Antoun L, Bouwsma E, Clark T, Di Spiezio Sardo A, Huirne J Facts Views Vis Obgyn. 2024; 16(3):263-280.

PMID: 39357857 PMC: 11569431. DOI: 10.52054/FVVO.16.3.041.

Presurgical treatment of uterine myomas with the GnRH-antagonist relugolix in combination therapy: an observational study.

Muzii L, Galati G, Mercurio A, Olivieri C, Scarcella L, Azenkoud I Sci Rep. 2024; 14(1):22481.

PMID: 39341875 PMC: 11438951. DOI: 10.1038/s41598-024-73151-y.

References

Glance L, Dick A, Mukamel D, Fleming F, Zollo R, Wissler R . Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology. 2011; 114(2):283-92. DOI: 10.1097/ALN.0b013e3182054d06. View

Carson J, Duff A, Poses R, Berlin J, Spence R, Trout R . Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet. 1996; 348(9034):1055-60. DOI: 10.1016/S0140-6736(96)04330-9. View

Goodnough L, Shander A, Spivak J, Waters J, Friedman A, Carson J . Detection, evaluation, and management of anemia in the elective surgical patient. Anesth Analg. 2005; 101(6):1858-1861. DOI: 10.1213/01.ANE.0000184124.29397.EB. View

Lasocki S, Krauspe R, von Heymann C, Mezzacasa A, Chainey S, Spahn D . PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery: a multicentre, observational study. Eur J Anaesthesiol. 2015; 32(3):160-7. DOI: 10.1097/EJA.0000000000000202. View

Dunne J, Gannon C, Osborn T, Taylor M, Malone D, Napolitano L . Preoperative anemia in colon cancer: assessment of risk factors. Am Surg. 2002; 68(6):582-7. View

Musallam K, Tamim H, Richards T, Spahn D, Rosendaal F, Habbal A . Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011; 378(9800):1396-407. DOI: 10.1016/S0140-6736(11)61381-0. View

Moskowitz D, McCullough J, Shander A, Klein J, Bodian C, Goldweit R . The impact of blood conservation on outcomes in cardiac surgery: is it safe and effective?. Ann Thorac Surg. 2010; 90(2):451-8. DOI: 10.1016/j.athoracsur.2010.04.089. View

Wu W, Schifftner T, Henderson W, Eaton C, Poses R, Uttley G . Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA. 2007; 297(22):2481-8. DOI: 10.1001/jama.297.22.2481. View

Baird D, Dunson D, Hill M, Cousins D, Schectman J . High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003; 188(1):100-7. DOI: 10.1067/mob.2003.99. View

10.

Spahn D, Shander A, Hofmann A . The chiasm: transfusion practice versus patient blood management. Best Pract Res Clin Anaesthesiol. 2013; 27(1):37-42. DOI: 10.1016/j.bpa.2013.02.003. View

11.

Moskowitz D, Klein J, Shander A, Cousineau K, Goldweit R, Bodian C . Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center. Ann Thorac Surg. 2004; 77(2):626-34. DOI: 10.1016/S0003-4975(03)01345-6. View

12.

Khuri S, Henderson W, Daley J, Jonasson O, Jones R, Campbell Jr D . The patient safety in surgery study: background, study design, and patient populations. J Am Coll Surg. 2007; 204(6):1089-102. DOI: 10.1016/j.jamcollsurg.2007.03.028. View

13.

Hung M, Besser M, Sharples L, Nair S, Klein A . The prevalence and association with transfusion, intensive care unit stay and mortality of pre-operative anaemia in a cohort of cardiac surgery patients. Anaesthesia. 2011; 66(9):812-8. DOI: 10.1111/j.1365-2044.2011.06819.x. View

14.

Wu W, Smith T, Henderson W, Eaton C, Poses R, Uttley G . Operative blood loss, blood transfusion, and 30-day mortality in older patients after major noncardiac surgery. Ann Surg. 2010; 252(1):11-7. DOI: 10.1097/SLA.0b013e3181e3e43f. View

15.

Spahn D . Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology. 2010; 113(2):482-95. DOI: 10.1097/ALN.0b013e3181e08e97. View

16.

Sabry M, Al-Hendy A . Medical treatment of uterine leiomyoma. Reprod Sci. 2012; 19(4):339-53. PMC: 3343067. DOI: 10.1177/1933719111432867. View

17.

van Klei W, Moons K, Leyssius A, Knape J, Rutten C, Grobbee D . A reduction in type and screen: preoperative prediction of RBC transfusions in surgery procedures with intermediate transfusion risks. Br J Anaesth. 2001; 87(2):250-7. DOI: 10.1093/bja/87.2.250. View

18.

Hogue Jr C, Goodnough L, Monk T . Perioperative myocardial ischemic episodes are related to hematocrit level in patients undergoing radical prostatectomy. Transfusion. 1998; 38(10):924-31. DOI: 10.1046/j.1537-2995.1998.381098440856.x. View

19.

Clevenger B, Richards T . Pre-operative anaemia. Anaesthesia. 2014; 70 Suppl 1:20-8, e6-8. DOI: 10.1111/anae.12918. View

20.

Hofmann A, Farmer S, Shander A . Five drivers shifting the paradigm from product-focused transfusion practice to patient blood management. Oncologist. 2011; 16 Suppl 3:3-11. DOI: 10.1634/theoncologist.2011-S3-3. View