Regular Article
Perioperative Anemia: An Independent Risk Factor for Infection, Mortality, and Resource Utilization in Surgery

https://doi.org/10.1006/jsre.2001.6330Get rights and content

Abstract

Background. Previous studies on patients with hip fractures and in patients with colorectal cancer have documented that perioperative transfusion is associated with a significant increase in postoperative infection rate. Therefore, we sought to investigate the incidence of preoperative and postoperative anemia in noncardiac surgical patients and to determine if transfusion is an independent risk factor for infection and adverse outcome postoperatively.

Methods. Prospective data from the National Veterans Administration Surgical Quality Improvement Program (NSQIP) was collected on 6301 noncardiac surgical patients at the Veterans Affairs Maryland Healthcare System from 1995 to 2000.

Results. The mean age of the study cohort was 61 ± 13. Descriptive data revealed 95% were male, 44% used tobacco, 19% were diabetic, 9% had COPD, 9% used alcohol, 3% used steroids, 1.7% had a diagnosis of cancer, and 1.2% had ascites. Preoperative anemia (hematocrit less than 36) was found in 33.9% and postoperative anemia was found in 84.1% of the study cohort. In the postoperative period, 32.5% of patients had a hematocrit of 26–30, and 26.5% had a hematocrit of 21–25. Mean units of blood transfused in the perioperative period ranged from 0.1 ± 0.9 in patients without anemia to 2.7 ± 2.9 in those with anemia. Incidence of pneumonia increased from 2.6 to 5% with increasing degree of anemia. Multiple logistic regression analysis documented that low preoperative hematocrit, low postoperative hematocrit, and increased blood transfusion rates were associated with increased mortality (P < 0.01), increased postoperative pneumonia (P ≤ 0.05), and increased hospital length of stay (P < 0.05).

Conclusion. There is a high incidence of preoperative and postoperative anemia in surgical patients, with a coincident increase in blood utilization. These factors are associated with increased risk for perioperative infection and adverse outcome (mortality) in surgical patients. Consideration should be given to preoperative diagnosis and correction of anemia with iron, vitamin B12, folate supplementation, or administration of recombinant human erythropoietin.

References (39)

  • N. Blumberg et al.

    Immunomodulation by blood transfusion: An evolving scientific and clinical challenge

    Am. J. Med.

    (1999)
  • P. Innerhofer et al.

    Immunologic changes after transfusion of autologous or allogeneic buffy coat poor versus white cell reduced blood to patients undergoing arthroplasty

    Transfusion

    (1999)
  • M.M. Heiss et al.

    Modulation of immune response by blood transfusion: Evidence for a differential effect of allogeneic and autologous blood in colorectal cancer surgery

    Shock

    (1997)
  • A. Avall et al.

    Postoperative inflammatory response after autologous and allogeneic blood transfusion

    Anesthesiology

    (1997)
  • K.J. Koval et al.

    Does blood transfusion increase the risk of infection after hip fracture?

    J. Orthop. Trauma

    (1997)
  • J.G. Houbiers et al.

    Transfusion of red cells is associated with increased incidence of bacterial infections in colorectal surgery: A prospective study

    Transfusion

    (1997)
  • S.F. Khuri et al.

    The Department of Veterans Affairs' NSQIP: The first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care

    Ann. Surg.

    (1998)
  • S.F. Khuri et al.

    The national veterans administration surgical risk study: Risk adjustment for the comparative assessment of the quality of surgical care

    J. Am. Coll. Surg.

    (1995)
  • A.M. Arozullah et al.

    Multifactorial risk index for predicting postoperative respiratory failure in men after major non-cardiac surgery

    Ann. Surg.

    (2000)
  • Cited by (0)

    1

    To whom correspondence should be addressed at 10 North Greene Street, Room 5C-122, Baltimore, MD 21201. Fax: (410)605-7919. E-mail: [email protected].

    View full text