Haemoglobin levels and outcomes of subgroups of patients with pre-operative anaemia based on red cell size: A retrospective cohort study

Sigurdur B. Benediktsson, Sigurbergur Kárason, Martin Ingi Sigurðsson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Pre-operative anaemia is common and associated with adverse outcomes. We hypothesised that pre-operative anaemia would be evident more than 1 month pre-operatively, and that peri-operative changes in haemoglobin and post-operative outcomes differed between red cell size-based subsets of anaemia. Methods: A retrospective single-centre cohort study, including all patients 18 years and older undergoing their first surgery at Landspitali between January 2006 and December 2018 with available measurement of haemoglobin (Hb) within 30 days preceding surgery. Clinical data were compared between patients with subgroups of anaemia classified by mean corpuscular volume (MCV) into microcytic (MCV < 80 fl), normocytic (MCV 80–100 fl), and macrocytic (MCV > 100 fl) anaemia. The development of haemoglobin measurements from a nationwide database was plotted from 1 year pre-operatively to 2 years post-operatively. Results: Of 40,979 patients, 10,505 (25.6%) had pre-operative anaemia, of which 1089 (10.4%) had microcytic anaemia, 9243 (88.0%) had normocytic anaemia, and 173 (1.6%) had macrocytic anaemia. Patients within all subgroups of pre-operative anaemia had a higher degree of comorbidity and frailty burden and a low haemoglobin evident for more than 100 days pre-operatively and similar changes post-operatively. Post-operative prolonged recovery of haemoglobin was slower for macrocytic anaemia than other types of anaemia. All groups of patients with anaemia had a higher incidence of 30-day mortality, acute kidney injury, and rate of readmission compared with patients without anaemia. Conclusions: Pre-operative anaemia is evident long prior to the procedure and its association with worse outcomes is similar regardless of red cell size.

Original languageEnglish
Pages (from-to)422-431
Number of pages10
JournalActa Anaesthesiologica Scandinavica
Volume67
Issue number4
DOIs
Publication statusPublished - Apr 2023

Bibliographical note

Funding Information:
The authors have declared no conflicts of interest for this article.

Publisher Copyright:
© 2023 Acta Anaesthesiologica Scandinavica Foundation.

Other keywords

  • anaemia
  • macrocytic
  • microcytic
  • normocytic
  • prehabilitation
  • Hemoglobins/analysis
  • Humans
  • Erythrocyte Indices
  • Cell Size
  • Anemia/epidemiology
  • Retrospective Studies
  • Cohort Studies
  • Anemia, Macrocytic/complications

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