Prevalence and intervention of preoperative anemia in Chinese adults: A retrospective cross-sectional study based on national preoperative anemia database

Jie Lin; Chao Wang; Junting Liu; Yang Yu; Shufang Wang; Aiqing Wen; Jufeng Wu; Long Zhang; Futing Sun; Xiaojun Guo; Fenghua Liu; Hailan Li; Na Li; Haibao Wang; Yi Lv; Zhonghua Jia; Xiaoyan Li; Jun Zhang; Zunyan Li; Shanshan Liu; Shuhuai Zhong; Jun Yang; Shuxuan Ma; Lingling Zhou; Xiaozhen Guan; Chunya Ma; Shijun Cheng; Shengxiong Chen; Zhenhua Xu; Gang Li; Deqing Wang

doi:10.1016/j.eclinm.2021.100894

Prevalence and intervention of preoperative anemia in Chinese adults: A retrospective cross-sectional study based on national preoperative anemia database

EClinicalMedicine. 2021 May 23:36:100894. doi: 10.1016/j.eclinm.2021.100894. eCollection 2021 Jun.

Authors

Jie Lin¹, Chao Wang², Junting Liu¹, Yang Yu¹, Shufang Wang¹, Aiqing Wen³, Jufeng Wu⁴, Long Zhang⁵, Futing Sun⁶, Xiaojun Guo⁷, Fenghua Liu⁸, Hailan Li⁹, Na Li¹⁰, Haibao Wang¹¹, Yi Lv¹², Zhonghua Jia¹³, Xiaoyan Li¹⁴, Jun Zhang¹⁵, Zunyan Li¹⁶, Shanshan Liu¹⁷, Shuhuai Zhong¹⁸, Jun Yang¹⁹, Shuxuan Ma²⁰, Lingling Zhou¹, Xiaozhen Guan¹, Chunya Ma¹, Shijun Cheng²¹, Shengxiong Chen²¹, Zhenhua Xu²¹, Gang Li², Deqing Wang¹

Affiliations

¹ Department of Transfusion Medicine, The First Medical Center of PLA General Hospital, Beijing, China.
² Institute of Statistics and Information, Beijing Center for Diseases Control and Prevention, Beijing, China.
³ Department of Blood Transfusion, Daping Hospital, Army Medical University, Chongqing, China.
⁴ Department of Blood Transfusion, Hainan Provincial People's Hospital, Haikou, Hainan, China.
⁵ Department of Blood Transfusion, Affiliated Hospital of Chifeng University, Inner Mongolia Autonomous Region, China.
⁶ Department of Blood Transfusion, Weifang People's Hospital, Shandong, China.
⁷ Department of Blood Transfusion, The First Hospital of Shanxi Medical University, Shanxi, China.
⁸ Department of Blood Transfusion, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, China.
⁹ Department of Blood Transfusion, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Zhuang Autonomous Region, China.
¹⁰ Department of Blood Transfusion, General Hospital of Easter Theater Command, Jiangsu, China.
¹¹ Department of Blood Transfusion, Hainan Hospital of PLA General Hospital, Hainan, China.
¹² Clinical Laboratory Medicine Center, Zhengzhou Yihe Hospital Affiliated to Henan University, Henan, China.
¹³ Department of Blood Transfusion, Gaoan People's Hospital, Jiangxi, China.
¹⁴ Department of Blood Transfusion, Baoji Central Hospital, Shaanxi, China.
¹⁵ Department of Blood Transfusion, The First Affiliated Hospital of Bengbu Medical College, Anhui, China.
¹⁶ Department of Blood Transfusion, Affiliated Hospital of Beihua University, Jilin, China.
¹⁷ Department of Blood Transfusion, The First People's Hospital of GuiYang, Guizhou, China.
¹⁸ Department of Blood Transfusion, Guizhou Provincial People's Hospital, Guizhou, China.
¹⁹ Department of Blood Transfusion, Zigong Fourth People's Hospital, Sichuan, China.
²⁰ Department of Blood Transfusion, Beijing Children's Hospital, Capital Medical University, Beijing, China.
²¹ HealSci Technology Co., Ltd, Beijing, China.

Abstract

Background: Preoperative anemia is an important pillar of perioperative patient blood management. However, there was no literature comprehensively described the current situation of preoperative anemia in China.

Methods: We conducted a national retrospective cross-sectional study to assess the prevalence and intervention of preoperative anemia in Chinese adults. Data were from the National Preoperative Anemia Database based on hospital administration data from January 1, 2013 to December 31, 2018.

Findings: A total of 797,002 patients were included for analysis. Overall, 27.57% (95% CI 27.47-27.67) of patients had preoperative anemia, which varied by gender, age, regions, and type of operation. Patients who were female, age over 60 years old, from South China, from provinces with lower per capita GDP, underwent operations on the lymphatic and hematopoietic system, with laboratory abnormalities were more likely to have a high risk of preoperative anemia. Among patients with preoperative anemia, 5.16% (95% CI 5.07-5.26) received red blood cell transfusion, 7.79% (95% CI 7.67-7.91) received anemia-related medications such as iron, erythropoietin, folic acid or vitamin B12, and 12.25% (95% CI 12.10-12.40) received anemia-related therapy (red blood cell transfusion or anemia-related medications) before operation. The probability of preoperative RBC transfusion decreased by 54.92% (OR 0.46, 95% CI 0.46-0.47) as each 10-g/L increase in preoperative hemoglobin. Patients with preoperative hemoglobin less than 130 g/L was associated with longer hospital stay and more hospital costs. Patients with severe preoperative anemia given iron preoperatively had lower intra/post-operative RBC transfusion rate, shorter length of stay and less hospitalization costs, but no similar correlation was found in patients with mild and moderate preoperative anemia and patients given erythropoietin preoperatively.

Interpretation: Our present study shows that preoperative anemia is currently a relatively prevalent problem that has not been fully appreciated in China. More researches will be required to optimize the treatment of preoperative anemia.

Funding: National Natural Science Foundation of China and the Logistics Support Department of the Central Military Commission.

Keywords: Erythropoietin; Iron; Preoperative anemia; Transfusion.