PMID- 35843746 OWN - NLM STAT- MEDLINE DCOM- 20220824 LR - 20230124 IS - 1471-6771 (Electronic) IS - 0007-0912 (Linking) VI - 129 IP - 3 DP - 2022 Sep TI - Postoperative anaemia and patient-centred outcomes after major abdominal surgery: a retrospective cohort study. PG - 346-354 LID - S0007-0912(22)00315-4 [pii] LID - 10.1016/j.bja.2022.06.014 [doi] AB - BACKGROUND: Compared with anaemia before surgery, the underlying pathogenesis and implications of postoperative anaemia are largely unknown. METHODS: 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. RESULTS: 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). CONCLUSIONS: Postoperative anaemia is common and is independently associated with poor outcomes after surgery. Optimal prevention and treatment strategies need to be investigated. CLINICAL TRIAL REGISTRATION: NCT04978285 (ClinicalTrials.gov). CI - Copyright (c) 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved. FAU - Myles, Paul S AU - Myles PS AD - Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Australia. Electronic address: p.myles@alfred.org.au. FAU - Richards, Toby AU - Richards T AD - Department of Surgery, University of Western Australia, Perth, Australia. FAU - Klein, Andrew AU - Klein A AD - Department of Anaesthesia, Papworth Hospital, Cambridge, UK. FAU - Wood, Erica M AU - Wood EM AD - Transfusion Research Unit, Monash University, Melbourne, Victoria, Australia; Department of Haematology, Monash Health, Clayton, Victoria, Australia. FAU - Wallace, Sophie AU - Wallace S AD - Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Australia. FAU - Shulman, Mark A AU - Shulman MA AD - Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Australia. FAU - Martin, Catherine AU - Martin C AD - Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. FAU - Bellomo, Rinaldo AU - Bellomo R AD - Intensive Care Unit, Austin Hospital, Heidelberg, Victoria, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia. FAU - Corcoran, Tomas B AU - Corcoran TB AD - Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia. FAU - Peyton, Philip J AU - Peyton PJ AD - Department of Critical Care, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia. FAU - Story, David A AU - Story DA AD - Department of Critical Care, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia. FAU - Leslie, Kate AU - Leslie K AD - Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia. FAU - Forbes, Andrew AU - Forbes A AD - Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. CN - RELIEF Trial Investigators LA - eng SI - ClinicalTrials.gov/NCT04978285 PT - Journal Article DEP - 20220715 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 SB - IM CIN - Br J Anaesth. 2023 Feb;130(2):e189-e190. PMID: 36435666 MH - Abdomen/surgery MH - Adult MH - *Anemia/epidemiology/etiology MH - Humans MH - Length of Stay MH - Postoperative Complications/epidemiology/etiology/prevention & control MH - Prospective Studies MH - Retrospective Studies OTO - NOTNLM OT - abdominal surgery OT - anaemia OT - anaesthesia OT - haemoglobin OT - iron OT - outcomes OT - postoperative EDAT- 2022/07/18 06:00 MHDA- 2022/08/25 06:00 CRDT- 2022/07/17 22:03 PHST- 2022/04/19 00:00 [received] PHST- 2022/06/17 00:00 [revised] PHST- 2022/06/19 00:00 [accepted] PHST- 2022/07/18 06:00 [pubmed] PHST- 2022/08/25 06:00 [medline] PHST- 2022/07/17 22:03 [entrez] AID - S0007-0912(22)00315-4 [pii] AID - 10.1016/j.bja.2022.06.014 [doi] PST - ppublish SO - Br J Anaesth. 2022 Sep;129(3):346-354. doi: 10.1016/j.bja.2022.06.014. Epub 2022 Jul 15.