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Preoperative anemia in older individuals undergoing major abdominal surgery is associated with early postoperative morbidity: a prospective observational study

L’anémie préopératoire chez les personnes âgées bénéficiant d’une chirurgie abdominale majeure est associée à une morbidité postopératoire précoce : une étude observationnelle prospective

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Abstract

Purpose

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.

Methods

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.

Results

A total of 469 patients were analyzed, 37.5% of whom had preoperative anemia (serum hemoglobin of < 13 g·dL−1 in males and < 12 g·dL−1 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.

Conclusion

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.

Résumé

Objectif

L’anémie préopératoire est associée à de mauvais devenirs postopératoires. Les patient·es plus âgé·es ont des réserves physiologiques limitées, ce qui les rend vulnérables au stress d’une chirurgie abdominale majeure. Nous avons cherché à déterminer si la gravité de l’anémie préopératoire était associée à une morbidité postopératoire précoce chez les personnes âgées bénéficiant d’une chirurgie abdominale majeure.

Méthode

L’approbation éthique a été obtenue auprès du Comité d’examen institutionnel centralisé SingHealth. Il s’agit d’une étude observationnelle prospective menée dans la clinique d’anesthésie préopératoire d’un hôpital tertiaire de Singapour de 2017 à 2021. Les données démographiques des patient·es, les comorbidités et les détails peropératoires ont été recueillis. Les critères d’évaluation comprenaient les transfusions sanguines, les complications selon l’Enquête sur la morbidité postopératoire, le nombre de jours de vie hors de l’hôpital, la durée de séjour à l’hôpital et la mortalité.

Résultats

Au total, 469 patient·es ont été analysé·es, dont 37,5% présentaient une anémie préopératoire (hémoglobine sérique < 13 g·dL-1 chez les hommes et < 12 g·dL-1 chez les femmes). L’anémie était significativement associée à un âge plus avancé, à un score plus élevé à l’Indice de complication globale ajusté en fonction de l’âge, à une incidence plus élevée de diabète sucré et à une proportion plus élevée de patient·es de statut physique III ou IV selon l’American Society of Anesthesiologists. La sévérité de l’anémie était associée à la présence d’une morbidité postopératoire précoce au jour 5, à une augmentation des transfusions sanguines, à une durée d’hospitalisation plus longue et à une diminution des jours en vie hors hôpital à 30 jours et six mois.

Conclusion

L’anémie est significativement associée aux moins bons devenirs postopératoires chez les personnes âgées. L’impact de l’anémie sur les devenirs postopératoires pourrait être évalué plus en détail à l’aide d’indicateurs de qualité de vie, de mesures des issues rapportées par les patient·es et d’outils d’économie de la santé.

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Author contributions

Phui S. Au Yong contributed to data analysis and interpretation and drafting and revising the manuscript. Yuhe Ke and Eunice J. Y. Kok contributed to data interpretation and revising the manuscript. Brenda P. Y. Tan contributed to data acquisition and manuscript revision. Hanis Abdul Kadir contributed to data analysis, interpretation, and manuscript drafting. Hairil R. Abdullah conceptualized and designed the project, drafted the protocols and reviewed the manuscript.

Disclosures

None.

Funding statement

This project was partially supported by the Singapore National Medical Research Council (NMRC) New Investigator Grant (HNIG16Dec003).

Prior conference presentations

Preliminary results were presented at Euroanaesthesia 2023 (3–5 June, Glasgow, UK).

Editorial responsibility

This submission was handled by Dr. Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore

    Phui S. Au Yong MMed, Yuhe Ke MMed, Eunice J. Y. Kok MBBS, Brenda P. Y. Tan MSc, Hanis Abdul Kadir MSc & Hairil R. Abdullah PhD

  2. Duke-NUS Medical School, Singapore, Singapore

    Phui S. Au Yong MMed, Yuhe Ke MMed & Hairil R. Abdullah PhD

  3. Health Services Research Unit, Singapore General Hospital, Singapore, Singapore

    Hanis Abdul Kadir MSc

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Yong, P.S.A., Ke, Y., Kok, E.J.Y. et al. Preoperative anemia in older individuals undergoing major abdominal surgery is associated with early postoperative morbidity: a prospective observational study. Can J Anesth/J Can Anesth 71, 353–366 (2024). https://doi.org/10.1007/s12630-023-02676-z

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