Preoperative Anemia Adversely Impacts Emergency Surgical Outcomes

Preoperative anemia is a prevalent condition among surgical patients and has been associated with an increased risk of perioperative complications and mortality. While the effects of anemia on elective surgical cases have been well-documented, its impact on emergency surgical patients remains relatively understudied.

According to authors of a study published in Heliyon, “[preoperative anemia] increases the risk of perioperative red blood cell (RBC) transfusion by about 30.7%, postoperative complications by about 33.2%, in-hospital mortality by about 4.9%, prolonged the length of hospital stay by about 46.2%, and unplanned readmission rate by around (11.4%). This increases health care costs, and economic burden, and impacts functional recovery after surgery.”

To evaluate the effect of preoperative anemia on perioperative outcomes among patients undergoing emergency surgery, researchers conducted a multicenter, prospective, cohort study.

A total of 200 patients who underwent emergency surgery were included in the study. Half of the patients (100) were classified into the anemia group and half were classified into the nonanemia group. Descriptive statistics, cross-tabulation, and multivariable binary logistic regression analyses were employed to analyze the data.

The study found no significant difference related to sociodemographic or intraoperative patient characteristics between the 2 groups. However, analysis of perioperative outcomes revealed notable distinctions.

Patients in the anemia group exhibited a significantly higher risk of requiring perioperative blood transfusions (relative risk [RR], 4.030; P<.001) compared with those in the nonanemia group.

Furthermore, patients with preoperative anemia experienced a higher incidence of postoperative complications (RR, 1.868; P=.017). Such complications can contribute to prolonged recovery periods, increased health care costs, and reduced quality of life for patients.

The study also demonstrated a significantly elevated risk of in-hospital mortality among patients in the anemia group (RR, 5.763; P=.045). This alarming result underscores the urgent need to address preoperative anemia in patients undergoing emergency surgery to minimize mortality rates.

Additionally, patients in the anemia group were more likely to require admission to the intensive care unit (ICU) postoperatively (RR, 6.332; P=.003). This finding suggests that anemia may exacerbate the severity of postoperative complications, necessitating more intensive care and resources. Finally, patients with preoperative anemia experienced a significantly prolonged length of hospital stay (RR, 4.028; P<.001). Prolonged hospitalization can strain health care facilities and hinder access to care for other patients.

“After controlling for potential confounders, we showed that preoperative anemia was associated with a higher rate of perioperative transfusion requirements, along with increased postoperative complications, increased in-hospital mortality, increased ICU admission rate, and prolonged length of hospital stay,” the authors of the study wrote.

The authors recommend a thorough preoperative assessment and correction of hemoglobin levels to improve surgical outcomes and reduce complications. Institutions and policymakers should develop specific policies for emergency surgery to minimize the impact of anemia on perioperative results, they emphasized. Larger studies with equal allocation for anemia subclassification are advised to better understand the association between anemia severity and perioperative outcomes in emergency surgery.