The association of pre‐operative anaemia with morbidity and mortality after emergency laparotomy. (21st April 2020)

• Record Type: Journal Article
• Authors: Boyd‐Carson, H.; Shah, A.; Sugavanam, A.; Reid, J.; Stanworth, S. J.; Oliver, C. M.
• Is Part Of: Anaesthesia. Volume 75:Number 7(2020)
• Page Start: 904
• Page End: 912
• Publication Date: 2020-04-21
• Subjects: anaemia and coagulation -- peri‐operative management; Anesthesia -- Periodicals; 617.96
• DOI: 10.1111/anae.15021
• Languages: English
• ISSNs: 0003-2409

Abstract

Summary: 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.