Preoperative anaemia and clinical outcomes in the South African Surgical Outcomes Study
Background. In high-income countries, preoperative anaemia has been associated with poor postoperative outcomes. To date, no large study has investigated this association in South Africa (SA). The demographics of SA surgical patients differ from those of surgical patients in the European and Norther...
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| Format: | Article |
| Language: | English |
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South African Medical Association
2018-10-01
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| Series: | South African Medical Journal |
| Online Access: | http://www.samj.org.za/index.php/samj/article/download/12431/8636 |
| _version_ | 1797368547905634304 |
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| author | D Marsicano N Hauser F Roodt E Cloete W Conradie V Morford D Nel D Bishop T Madiba B Biccard; on behalf of the South African Surgical Outcomes Study investigators |
| author_facet | D Marsicano N Hauser F Roodt E Cloete W Conradie V Morford D Nel D Bishop T Madiba B Biccard; on behalf of the South African Surgical Outcomes Study investigators |
| author_sort | D Marsicano |
| collection | DOAJ |
| description | Background. In high-income countries, preoperative anaemia has been associated with poor postoperative outcomes. To date, no large study has investigated this association in South Africa (SA). The demographics of SA surgical patients differ from those of surgical patients in the European and Northern American settings from which the preoperative anaemia data were derived. These associations between preoperative anaemia and postoperative outcomes are therefore not necessarily transferable to SA surgical patients.Objectives. The primary objective was to determine the association between preoperative anaemia and in-hospital mortality in SA adult non-cardiac, non-obstetric patients. The secondary objectives were to describe the association between preoperative anaemia and (i) critical care admission and (ii) length of hospital stay, and the prevalence of preoperative anaemia in adult SA surgical patients.Methods. We performed a secondary analysis of the South African Surgical Outcomes Study (SASOS), a large prospective observational study of patients undergoing inpatient non-cardiac, non-obstetric surgery at 50 hospitals across SA over a 1-week period. To determine whether preoperative anaemia is independently associated with mortality or admission to critical care following surgery, we conducted a multivariate logistic regression analysis that included all the independent predictors of mortality and admission to critical care identified in the original SASOS model.Results. The prevalence of preoperative anaemia was 1 727/3 610 (47.8%). Preoperative anaemia was independently associated with in-hospital mortality (odds ratio (OR) 1.657, 95% confidence interval (CI) 1.055 - 2.602; p=0.028) and admission to critical care (OR 1.487, 95% CI 1.081 - 2.046; p=0.015).Conclusions. Almost 50% of patients undergoing surgery at government-funded hospitals in SA had preoperative anaemia, which was independently associated with postoperative mortality and critical care admission. These numbers indicate a significant perioperative risk, with a clear need for quality improvement programmes that may improve surgical outcomes. Long waiting lists for elective surgery allow time for assessment and correction of anaemia preoperatively. With a high proportion of patients presenting for urgent or emergency surgery, perioperative clinicians in all specialties should educate themselves in the principles of patient blood management. |
| first_indexed | 2024-03-08T17:34:03Z |
| format | Article |
| id | doaj.art-c90d004eb7dd416495dc431b80d6ad75 |
| institution | Directory Open Access Journal |
| issn | 0256-9574 2078-5135 |
| language | English |
| last_indexed | 2024-03-08T17:34:03Z |
| publishDate | 2018-10-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj.art-c90d004eb7dd416495dc431b80d6ad752024-01-02T13:43:56ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352018-10-011081083984610.7196/SAMJ.2018.v108i10.13148Preoperative anaemia and clinical outcomes in the South African Surgical Outcomes StudyD MarsicanoN HauserF RoodtE CloeteW ConradieV MorfordD NelD BishopT MadibaB Biccard; on behalf of the South African Surgical Outcomes Study investigatorsBackground. In high-income countries, preoperative anaemia has been associated with poor postoperative outcomes. To date, no large study has investigated this association in South Africa (SA). The demographics of SA surgical patients differ from those of surgical patients in the European and Northern American settings from which the preoperative anaemia data were derived. These associations between preoperative anaemia and postoperative outcomes are therefore not necessarily transferable to SA surgical patients.Objectives. The primary objective was to determine the association between preoperative anaemia and in-hospital mortality in SA adult non-cardiac, non-obstetric patients. The secondary objectives were to describe the association between preoperative anaemia and (i) critical care admission and (ii) length of hospital stay, and the prevalence of preoperative anaemia in adult SA surgical patients.Methods. We performed a secondary analysis of the South African Surgical Outcomes Study (SASOS), a large prospective observational study of patients undergoing inpatient non-cardiac, non-obstetric surgery at 50 hospitals across SA over a 1-week period. To determine whether preoperative anaemia is independently associated with mortality or admission to critical care following surgery, we conducted a multivariate logistic regression analysis that included all the independent predictors of mortality and admission to critical care identified in the original SASOS model.Results. The prevalence of preoperative anaemia was 1 727/3 610 (47.8%). Preoperative anaemia was independently associated with in-hospital mortality (odds ratio (OR) 1.657, 95% confidence interval (CI) 1.055 - 2.602; p=0.028) and admission to critical care (OR 1.487, 95% CI 1.081 - 2.046; p=0.015).Conclusions. Almost 50% of patients undergoing surgery at government-funded hospitals in SA had preoperative anaemia, which was independently associated with postoperative mortality and critical care admission. These numbers indicate a significant perioperative risk, with a clear need for quality improvement programmes that may improve surgical outcomes. Long waiting lists for elective surgery allow time for assessment and correction of anaemia preoperatively. With a high proportion of patients presenting for urgent or emergency surgery, perioperative clinicians in all specialties should educate themselves in the principles of patient blood management.Âhttp://www.samj.org.za/index.php/samj/article/download/12431/8636 |
| spellingShingle | D Marsicano N Hauser F Roodt E Cloete W Conradie V Morford D Nel D Bishop T Madiba B Biccard; on behalf of the South African Surgical Outcomes Study investigators Preoperative anaemia and clinical outcomes in the South African Surgical Outcomes Study South African Medical Journal |
| title | Preoperative anaemia and clinical outcomes in the South African Surgical Outcomes Study |
| title_full | Preoperative anaemia and clinical outcomes in the South African Surgical Outcomes Study |
| title_fullStr | Preoperative anaemia and clinical outcomes in the South African Surgical Outcomes Study |
| title_full_unstemmed | Preoperative anaemia and clinical outcomes in the South African Surgical Outcomes Study |
| title_short | Preoperative anaemia and clinical outcomes in the South African Surgical Outcomes Study |
| title_sort | preoperative anaemia and clinical outcomes in the south african surgical outcomes study |
| url | http://www.samj.org.za/index.php/samj/article/download/12431/8636 |
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