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The association of pre-operative anaemia with morbidity and mortality after emergency laparotomy

Boyd-Carson, H; Shah, A; Sugavanam, A; Reid, J; Stanworth, SJ; Oliver, CM; (2020) The association of pre-operative anaemia with morbidity and mortality after emergency laparotomy. Anaesthesia , 75 (7) pp. 904-912. 10.1111/anae.15021. Green open access

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Abstract

Pre‐operative anaemia is associated with poor outcomes after elective surgery but its relationship with outcomes after emergency surgery is unclear. We analysed National Emergency Laparotomy Audit data from 1 December 2013 to 30 November 2017, excluding laparotomy for haemorrhage. Anaemia was classified as ‘mild’ 129–110 g.l−1; ‘moderate’ 109–80 g.l−1; or ‘severe’ ≤ 79 g.l−1. The primary outcome was 90‐day mortality. Secondary outcomes were 30‐day mortality, return to theatre and postoperative hospital stay. The primary outcome was available for 86,763 patients, of whom 45,306 (52%) were anaemic. There were 12,667 (15%) deaths at 90 postoperative days and 9246 (11%) deaths at 30 postoperative days. Anaemia was associated with increased 90‐day and 30‐day mortality, odds ratio (95%CI ): mild, 1.15 (1.09–1.21); moderate, 1.44 (1.36–1.52); and severe, 1.42 (1.24–1.63), p < 0.001 for all; mild, 1.07 (1.00–1.12), p = 0.030; moderate, 1.30 (1.21–1.38), p < 0.001; and severe, 1.22 (1.05–1.43), p = 0.010, respectively. All categories of anaemia were associated with prolonged hospital stay, adjusted coefficient (95%CI ): mild, 1.31 (1.01–1.62); moderate, 3.41 (3.04–3.77); severe, 2.80 (1.83–3.77), p < 0.001 for all. Moderate and severe anaemia were associated with increased risk of return to the operating theatre, odds ratio (95%CI ): moderate 1.13 (1.06–1.21), p < 0.001; and severe 1.23 (1.06–1.43), p = 0.006. Pre‐operative anaemia is common in patients undergoing emergency laparotomy and is associated with increased postoperative mortality and morbidity.

Type: Article
Title: The association of pre-operative anaemia with morbidity and mortality after emergency laparotomy
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/anae.15021
Publisher version: https://doi.org/10.1111/anae.15021
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: anaemia and coagulation, peri-operative management
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
URI: https://discovery.ucl.ac.uk/id/eprint/10107406
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