The association between preoperative anemia and postoperative morbidity in pediatric surgical patients: A secondary analysis of a prospective observational cohort study

Heidi M Meyer; Alexandra Torborg; Larissa Cronje; Jennifer Thomas; Anisa Bhettay; Johan Diedericks; Celeste Cilliers; Hyla Kluyts; Busisiwe Mrara; Mandisa Kalipa; Bruce Biccard; SAPSOS investigators

doi:10.1111/pan.13872

The association between preoperative anemia and postoperative morbidity in pediatric surgical patients: A secondary analysis of a prospective observational cohort study

Paediatr Anaesth. 2020 Jul;30(7):759-765. doi: 10.1111/pan.13872.

Authors

Collaborators

SAPSOS investigators:
K Allopi, U Singh, P Diyelela-Ndwandwa, N Nongqo, B Ravid, P Anamourlis, G Coetzee, M Dlamini, C Foster, P Mogane, D Nel, A Oosthuizen, L Redford, R Murray, C Basson, J Joubert, N Tshifularo, T Els, J Orrock, M Muthambi, T Matebesi, G Tshukudu, D Maela, N Allorto, J Bertie, D Bishop, K Chetty, M Grobbelaar, R Wise, I von Steiger, P Nundlal, E Garoufalias, G Westcott, J Davids, C Rajah, R Rodseth, C Cairns, Y Mzoneli, K Bhagwan, E Cloete, M Jaworska, E Semenya, O Porrill, R Mungar, P Seonandan, N Perumal, C Alphonsus, M Bosman, A De Castro, L Drummond, M Du Bruyn, P Govender, T Hardcastle, Z Hlangu, P Jeena, M Mbuyisa, T Naidu, J Sewlall, J Taylor, K Timakia, W Van der Walt, T Biyase, Z Khumalo, B Kusel, I Mukama, M Ramburuth, S Singaram, M Mbeki, H Schutte, P Anderson, B Dorasamy, P Kint, S Goga, L Cronjé, N Dube, S Jithoo, L Naidoo, L Naidu, T Reddy, Y Saman, D Rungan, K Naidoo, K Kabambi, N Mgoqo, M Mofoka, A Usenbo, C Chiu, N Machere, D Maiwald, G Davies, T Serdyn, P Gokal, N Dhanjee, M Wege, S Govender, S Tarr, M Moodley, M Balkisson, A Maharaj, S Ngcobo, N Rorke, S Sikhakhane, M Khumalo, T Ramsamy, K Kabongo, W Kuhn, R Matos-Puig, R Naidoo, A Thotharam, A Chohan, S Adam, I Appel, A Burke, C de Vos, S Gautam, E Joubert, R Rautenbach, D Roytowski, A Szpytko, E Brits, G Naude, J van Niekerk, Z Fullerton

Affiliations

¹ Division of Paediatric Anaesthesia, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
² Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
³ Department of Anaesthesiology, University of the Free State, Bloemfontein, South Africa.
⁴ Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa.
⁵ Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
⁶ Department of Anaesthesia, Walter Sisulu University, Mthatha, South Africa.
⁷ Department of Anaesthesiology, University of Pretoria, Pretoria, South Africa.
⁸ Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.

PMID: 32275796
DOI: 10.1111/pan.13872

Abstract

Background: The prevalence of anemia in the South African pediatric surgical population is unknown. Anemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low- and middle-income countries (LMICs).

Aim: The primary aim of this study was to describe the association between preoperative anemia and 26 defined postoperative complications, in noncardiac pediatric surgical patients. Secondary aims included describing the prevalence of anemia and risk factors for intraoperative blood transfusion.

Method: This was a secondary analysis of the South African Paediatric Surgical Outcomes Study, a prospective, observational surgical outcomes study. Inclusion criteria were all consecutive patients aged between 6 months and <16 years, presenting to participating centers during the study period who underwent elective and nonelective noncardiac surgery and had a preoperative hemoglobin recorded. Exclusion criteria were patients aged <6 months, undergoing cardiac surgery, or without a preoperative Hb recorded. To determine whether an independent association existed between preoperative anemia and postoperative complications, a hierarchical stepwise logistic regression was conducted.

Results: There were 1094 eligible patients. In children in whom a preoperative Hb was recorded 46.2% had preoperative anemia. Preoperative anemia was independently associated with an increased risk of any postoperative complication (odds ratio 2.0, 95% confidence interval: 1.3-3.1, P = .002). Preoperative anemia (odds ratio 3.6, 95% confidence interval: 1.8-7.1, P < .001) was an independent predictor of intraoperative blood transfusion.

Conclusion: Preoperative anemia had a high prevalence in a LMIC and was associated with increased postoperative complications. The main limitation of our study is the ability to generalize the results to the wider pediatric surgical population, as these findings only relate to children in whom a preoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anemia reduces morbidity and mortality in children undergoing noncardiac surgery.

Keywords: adverse effects; anemia; complication; pediatric surgery; perioperative period; surgery.

Publication types

Observational Study

MeSH terms

Anemia* / complications
Anemia* / epidemiology
Blood Transfusion
Child
Humans
Infant
Morbidity
Postoperative Complications / epidemiology
Prospective Studies
Retrospective Studies
Risk Factors