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The Association of Preoperative Hematocrit and Transfusion with Mortality in Patients Undergoing Elective Non-cardiac Surgery

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Abstract

Background

Patients with anemia frequently undergo surgery, as it is unclear at what threshold clinicians should consider delaying surgery for preoperative anemia optimization. The primary objective of this study was to determine whether there is an association of varying degrees of anemia and transfusion with 30-day mortality.

Methods

This is a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2013. Cohorts were analyzed based on preoperative hematocrit range—patients with: (1) no anemia, (2) hematocrit ≥33% and <36% in females or <39% in males, (3) hematocrit ≥30% and <33%, (4) hematocrit ≥27% and <30%, (5) hematocrit ≥24% and <27%, and (6) hematocrit ≥21% and less than 24%. Multivariable logistic regression was used to analyze the association of anemia and transfusion with 30-day in-hospital mortality.

Results

The odds for 30-day mortality increased incrementally as the hematocrit ranges decreased, in which preoperative hematocrit between 21 and 24% had the highest odds for this outcome (odds ratio [OR] 6.50, p < 0.0001) compared to the reference group (no anemia). The use of transfusion increased the odds of mortality even further (OR 5.57, p < 0.0001). Among patients that received an intra-/postoperative transfusion, preoperative anemia was not predictive of mortality.

Conclusions

Healthcare providers making preoperative clinical decisions for patients undergoing elective surgery should consider the degree of preoperative anemia and likelihood of perioperative transfusion.

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Funding

Funding support from National Library of Medicine (NLM) training Grant Number T15LM011271.

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Authors and Affiliations

  1. Department of Biomedical Informatics, University of California, San Diego, CA, USA

    Rodney A. Gabriel

  2. Department of Anesthesiology, University of California, San Diego, 9500 Gilman Dr, MC 0881, La Jolla, San Diego, CA, 92093-0881, USA

    Rodney A. Gabriel, Anthony I. Clark, Albert P. Nguyen, Ruth S. Waterman & Ulrich H. Schmidt

Authors
  1. Rodney A. Gabriel
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  2. Anthony I. Clark
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  3. Albert P. Nguyen
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  4. Ruth S. Waterman
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  5. Ulrich H. Schmidt
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Contributions

RAG helped design the study, conduct the study, collect the data, analyze the data, and prepare the manuscript. AIC helped conduct the study, analyze the data, and prepare the manuscript. APN helped conduct the study, analyze the data, and prepare the manuscript. RSW helped design the study, analyze the data and prepare the manuscript. UHS helped design the study, analyze the data, and prepare the manuscript.

Corresponding author

Correspondence to Rodney A. Gabriel.

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Gabriel, R.A., Clark, A.I., Nguyen, A.P. et al. The Association of Preoperative Hematocrit and Transfusion with Mortality in Patients Undergoing Elective Non-cardiac Surgery. World J Surg 42, 1939–1948 (2018). https://doi.org/10.1007/s00268-017-4359-y

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  • DOI: https://doi.org/10.1007/s00268-017-4359-y

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