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Title: Postoperative anaemia and patient-centred outcomes after major abdominal surgery: a retrospective cohort study.
Austin Authors: Myles, Paul S;Richards, Toby;Klein, Andrew;Wood, Erica M;Wallace, Sophie;Shulman, Mark A;Martin, Catherine;Bellomo, Rinaldo ;Corcoran, Tomás B;Peyton, Philip J ;Story, David A ;Leslie, Kate;Forbes, Andrew
Affiliation: Department of Haematology, Monash Health, Clayton, Victoria, Australia..
Intensive Care
Department of Surgery, University of Western Australia, Perth, Australia..
Transfusion Research Unit, Monash University, Melbourne, Victoria, Australia..
Department of Critical Care, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia..
Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Australia..
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia..
Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia..
Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia..
Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia..
Department of Anaesthesia, Papworth Hospital, Cambridge, UK..
Issue Date: Sep-2022 2022
Publication information: British Journal of Anaesthesia 2022; 129(3): 346-354
Abstract: Compared with anaemia before surgery, the underlying pathogenesis and implications of postoperative anaemia are largely unknown. This retrospective cohort study analysed prospective data obtained from 2983 adult patients across 47 centres enrolled in a clinical trial evaluating restrictive and liberal intravenous fluids. The primary endpoint was persistent disability or death up to 90 days after surgery. Secondary endpoints included major septic complications, hospital stay, and patient quality of recovery using a 15-item quality of recovery (QoR-15) score, hospital re-admissions, and disability-free survival up to 12 months after surgery. Anaemia and disability were defined according to the WHO definitions. Multivariable regression was used to adjust for baseline risk and surgery. A total of 2983 patients met inclusion criteria for this study, of which 78.5% (95% confidence interval [CI], 76.7-80.1%) had postoperative anaemia. Patients with postoperative anaemia had a higher adjusted risk of death or disability up to 90 days after surgery when compared with those without anaemia: 18.2% vs 9.2% (risk ratio [RR]=1.51; 95% CI, 1.10-2.07, P=0.011); lower QoR-15 scores on Day 3 and Day 30, 105 (95% CI, 87-119) vs 114 (95% CI, 99-128; P<0.001), and 130 (95% CI, 112-140) vs 139 (95% CI, 121-144; P<0.011), respectively; higher adjusted risk of a composite of mortality/septic complications, 2.01 (95% CI, 1.55-42.67; P<0.001); unplanned admission to ICU (RR=2.65; 95% CI, 1.65-4.23; P<0.001); and longer median (inter-quartile range [IQR]) hospital stays, 6.6 (4.4-12.4) vs 3.7 (2.5-6.5) days (P<0.001). Postoperative anaemia is common and is independently associated with poor outcomes after surgery. Optimal prevention and treatment strategies need to be investigated. NCT04978285 (
DOI: 10.1016/j.bja.2022.06.014
ORCID: 0000-0002-1650-8939
Journal: British Journal of Anaesthesia
PubMed URL: 35843746
PubMed URL:
Type: Journal Article
Subjects: abdominal surgery
Appears in Collections:Journal articles

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