Research

Preoperative anaemia and clinical outcomes in the South African Surgical Outcomes Study

D Marsicano, N Hauser, F Roodt, E Cloete, W Conradie, V Morford, D Nel, D G Bishop, T E Madiba, B M Biccard; on behalf of the South African Surgical Outcomes Study investigators

Abstract


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.

 


Authors' affiliations

D Marsicano, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

N Hauser, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Pain Medicine, Fiona Stanley and Fremantle Hospital Group, Perth, Australia

F Roodt, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

E Cloete, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, New Somerset Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

W Conradie, Department of Surgery, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

V Morford, Department of Anaesthesia, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

D Nel, Department of Anaesthesia, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

D G Bishop, Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

T E Madiba, Department of Surgery, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

B M Biccard; on behalf of the South African Surgical Outcomes Study investigators, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town

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Keywords

Anaemia; Preoperative care; Surgical outcomes; Epidemiology; South Africa

Cite this article

South African Medical Journal 2018;108(10):839-846. DOI:10.7196/SAMJ.2018.v108i10.13148

Article History

Date submitted: 2018-10-02
Date published: 2018-10-02

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