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. 2024 Aug;79(8):839-848.
doi: 10.1111/anae.16291. Epub 2024 Apr 12.

Associations between postoperative anaemia and unplanned readmission to hospital after major surgery: a retrospective cohort study†

Timothy Makar  1   2 , Margaret Hezkial  2 , Mayank Vasudeva  2 , Dominic Walpole  2 , John Xie  2 , Chris Zi-Fan Zhao  2 , Bobby Ou Yang  2 , Saranya Ramesh  2 , Tom Larsen  3 , Stephane Heritier  4 , Toby Richards  5 , Lachlan F Miles  1   2
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Free article

Associations between postoperative anaemia and unplanned readmission to hospital after major surgery: a retrospective cohort study†

Timothy Makar et al. Anaesthesia. 2024 Aug.
Free article

Abstract

Background: Anaemia following major surgery may be associated with unplanned readmission to hospital. However, the severity-response relationship between the degree of anaemia at discharge and the risk of unplanned readmission is poorly defined. We aimed to describe the severity-response relationship between haemoglobin concentration at the time of discharge and the risk of unplanned readmission in a cohort of patients undergoing different types of major surgery.

Methods: We performed a retrospective cohort study in a single tertiary health service, including all patients who underwent major surgery (orthopaedic, abdominal, cardiac or thoracic) between 1 May 2011 and 1 February 2022. The primary outcome was unplanned readmission to hospital in the 90 days following discharge after the index surgical procedure. These complex, non-linear relationships were modelled with restricted cubic splines.

Results: We identified 22,134 patients and included 14,635 in the primary analysis, of whom 1804 (12%) experienced at least one unplanned readmission. The odds of unplanned readmission rose when the discharge haemoglobin concentration was < 100 g.l-1 (p < 0.001). On subgroup analysis, the haemoglobin threshold below which odds of readmission began to increase appeared to be higher in patients undergoing emergency surgery (110 g.l-1; p < 0.001) compared with elective surgery. Declining discharge haemoglobin concentration was associated with increased odds ratios (95%CI) of unplanned readmission in patients undergoing orthopaedic (1.08 (1.01-1.15), p = 0.03), abdominal (1.13 (1.07-1.19), p < 0.001) and thoracic (1.12 (1.01-1.24), p = 0.03) procedures, but not cardiac surgery (1.09 (0.99-1.19), p = 0.07).

Conclusions: Our findings suggest that a haemoglobin concentration < 100 g.l-1 following elective procedures and < 110 g.l-1 following emergency procedures, at the time of hospital discharge after major surgery, was associated with unplanned readmission. Future interventional trials that aim to treat postoperative anaemia and reduce unplanned readmission should include patients with discharge haemoglobin below these thresholds.

Keywords: cardiac surgery; general surgery; iron deficiency anaemia; orthopaedic surgery; thoracic surgery.

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References

    1. Glance LG, Kellerman AL, Osler TM, et al. Hospital readmission after noncardiac surgery: the role of major complications. JAMA Surg 2014; 149: 439–445. https://doi.org/10.1001/jamasurg.2014.4.
    1. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Determinants of long‐term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 2005; 123: 32–48. https://doi.org/10.1097/01.sla.0000179621.33268.83.
    1. Ludbrook G, Riedel B, Martin D, Williams H. Improving outcomes after surgery: a roadmap for delivering the value proposition in perioperative care. ANZ J Surg 2021; 91: 225–228. https://doi.org/10.1111/ans.16571.
    1. Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta‐analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg 2015; 102: 1314–1324. https://doi.org/10.1002/bjs.9861.
    1. Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non‐cardiac surgery: a retrospective cohort study. Lancet 2011; 378: 1396–1407. https://doi.org/10.1016/S0140‐6736(11)61381‐0.

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