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Observational Study
. 2018 Apr 18;8(1):6226.
doi: 10.1038/s41598-018-24556-z.

Preoperative Red Cell Distribution Width and 30-day mortality in older patients undergoing non-cardiac surgery: a retrospective cohort observational study

H R Abdullah  1 , Y E Sim  2 , Y T Sim  3 , A L Ang  4 , Y H Chan  5 , T Richards  6 , B C Ong  7
Affiliations
Observational Study

Preoperative Red Cell Distribution Width and 30-day mortality in older patients undergoing non-cardiac surgery: a retrospective cohort observational study

H R Abdullah et al. Sci Rep. .

Abstract

Increased red cell distribution width (RDW) is associated with poorer outcomes in various patient populations. We investigated the association between preoperative RDW and anaemia on 30-day postoperative mortality among elderly patients undergoing non-cardiac surgery. Medical records of 24,579 patients aged 65 and older who underwent surgery under anaesthesia between 1 January 2012 and 31 October 2016 were retrospectively analysed. Patients who died within 30 days had higher median RDW (15.0%) than those who were alive (13.4%). Based on multivariate logistic regression, in our cohort of elderly patients undergoing non-cardiac surgery, moderate/severe preoperative anaemia (aOR 1.61, p = 0.04) and high preoperative RDW levels in the 3rd quartile (>13.4% and ≤14.3%) and 4th quartile (>14.3%) were significantly associated with increased odds of 30-day mortality - (aOR 2.12, p = 0.02) and (aOR 2.85, p = 0.001) respectively, after adjusting for the effects of transfusion, surgical severity, priority of surgery, and comorbidities. Patients with high RDW, defined as >15.7% (90th centile), and preoperative anaemia have higher odds of 30-day mortality compared to patients with anaemia and normal RDW. Thus, preoperative RDW independently increases risk of 30-day postoperative mortality, and future risk stratification strategies should include RDW as a factor.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study recruitment flow. Flowchart of Cohort Derivation. GA = general anesthesia; RA = regional anaesthesia.
Figure 2
Figure 2
Receiver Operating Curve (ROC) of Red Cell Distribution Width (RDW) in predicting 30-day mortality.
Figure 3
Figure 3
Adjusted Odds Ratio (aOR) for various degrees of anaemia stratified by red blood cell distribution width (RDW) levels and their 95% Confidence Intervals (CI) plotted on a log scale for the effect of anaemia stratified by RDW on 30-day mortality. Variables for adjustment are listed in Table 3, except anaemia and RDW.
See this image and copyright information in PMC

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