Preoperative Anaemia and Associated Postoperative Outcomes in Noncardiac Surgery Patients in Central Region of Ghana

Factors associated with increased risk of postoperative blood transfusion in patients undergoing total hip arthroplasty at an Irish University Hospital

INTRODUCTION

Approximately 7000 total hip arthroplasty (THA) surgeries occur in Ireland each year. A number of preoperative factors have been identified that increase the risk of postoperative blood transfusion after THA, including anaemia. The ability to identify patients at risk may allow preoperative management strategies to reduce blood transfusions. Data from Irish orthopaedic patients is currently lacking.

AIM

To investigate if preoperative anaemia and other factors are associated with postoperative blood transfusions in patients who undergo THA.

METHODS

A retrospective cohort study of all patients who underwent THA in 2019 in SIVUH, Cork, using medical chart review.

RESULTS

In total, 350 charts met the inclusion criteria, with 291 charts reviewed. 8.9% of the patients who underwent THA had preoperative anaemia. Among these, 19.2% had a postoperative blood transfusion, compared to 1.5% of patients who were not anaemic preoperatively. The odds of receiving a blood transfusion was 15.5 times greater in the preoperative anaemia group compared to the non-anaemic group. Increasing age and higher ASA scores were associated with preoperative anaemia and postoperative blood transfusions. Length of stay was increased by 2.2 days (p < 0.00016) if blood transfusion was required.

CONCLUSION

Preoperative anaemia was common in an Irish orthopaedic population undergoing THA. Preoperative anaemia predisposes patients to the greatest increased risk of postoperative blood transfusions. The other factors associated with the need for postoperative transfusion were ASA grade 3 or more and age greater than 65 years. Patients who received postoperative blood transfusions had a significantly increased length of hospital stay.

Ensemble learning-assisted prediction of prolonged hospital length of stay after spine correction surgery: a multi-center cohort study

PURPOSE

This research aimed to develop a machine learning model to predict the potential risk of prolonged length of stay in hospital before operation, which can be used to strengthen patient management.

METHODS

Patients who underwent posterior spinal deformity surgery (PSDS) from eleven medical institutions in China between 2015 and 2022 were included. Detailed preoperative patient data, including demographics, medical history, comorbidities, preoperative laboratory results, and surgery details, were collected from their electronic medical records. The cohort was randomly divided into a training dataset and a validation dataset with a ratio of 70:30. Based on Boruta algorithm, nine different machine learning algorithms and a stack ensemble model were trained after hyperparameters tuning visualization and evaluated on the area under the receiver operating characteristic curve (AUROC), precision-recall curve, calibration, and decision curve analysis. Visualization of Shapley Additive exPlanations method finally contributed to explaining model prediction.

RESULTS

Of the 162 included patients, the K Nearest Neighbors algorithm performed the best in the validation group compared with other machine learning models (yielding an AUROC of 0.8191 and PRAUC of 0.6175). The top five contributing variables were the preoperative hemoglobin, height, body mass index, age, and preoperative white blood cells. A web-based calculator was further developed to improve the predictive model's clinical operability.

CONCLUSIONS

Our study established and validated a clinical predictive model for prolonged postoperative hospitalization duration in patients who underwent PSDS, which offered valuable prognostic information for preoperative planning and postoperative care for clinicians. Trial registration ClinicalTrials.gov identifier NCT05867732, retrospectively registered May 22, 2023, https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05867732 .

Prevalence and risk factors of preoperative anemia in patients undergoing elective orthopedic procedures in Northwest Ethiopia: a multicenter prospective observational cohort study

BACKGROUND

Preoperative anemia is a common hematologic problem in major orthopedic surgery in developing countries. It is a condition in which the number and size of red blood cells are insufficient to meet the body's physiologic needs, consequently impairing the capacity of the blood to transport oxygen to the body. Preoperative anemia is common in elective orthopedic surgical patients and is an independent risk factor for perioperative morbidity and mortality. This study aimed to assess preoperative anemia prevalence and risk factors in patients undergoing elective orthopedic procedures.

METHOD

A multicenter prospective observational cohort study was conducted from June 01 to August 30, 2022. A systematic random sampling technique was used to select the study unit. Data were collected using a structured questionnaire. Descriptive statistics were expressed in percentages and presented with tables and figures. Binary logistic regression was used to see the association between independent and dependent variables. A P-value < 0.05 was considered statistically significant.

RESULT

Preoperative anemia's prevalence and risk factors in patients undergoing elective orthopedic procedures was 24.1[95%CI= (18.2-30.6)]. Multivariable logistic analyses showed that low monthly income level [AOR:5,95%CI:(1.36-7.98)], patient with cancer [AOR:3.4,95%CI:(3.7-8.84)], patient with malaria infectious [AOR: 3.2,95%CI:( 1.13-8.91)], patient with anti-retroviral therapy [AOR: 5.2,95%CI:( 1.8-11.04)], and previous history of surgery [AOR:1,95%CI(1.43-2.4)], were factors significantly associated with preoperative anemia.

CONCLUSION

The prevalence of preoperative anemia among adult patients who underwent elective orthopedics procedures was high. Low Monthly income, patients with cancer, patient with malaria infection, and patients with anti-retroviral therapy, previous histories of surgery were found significantly associated with preoperative anemia. So, we recommend to health professional's early identification, diagnosis and treatment of preoperative anemia should be done to reduce the risks of anemia and related adverse outcomes.

Prevalence and factors associated with preoperative anemia among adult patients scheduled for major elective surgery at University hospital in Northwest Ethiopia; a cross-sectional study

BACKGROUND

Anemia is the most common hematological finding in surgical patients. One-third of surgical patients were anemic during preoperative assessment. The presence of preoperative anemia was found to be related with increased morbidity, mortality, length of hospital stay, intensive care unit admissions and postoperative infections.

OBJECTIVE

To determine the prevalence and factors associated with preoperative anemia among adult patients scheduled for major elective surgery at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2020.

METHODS

After obtaining an ethical approval, hospital-based cross-sectional quantitative study was conducted from June to August 2020 in University of Gondar Hospital. Full blood count within two weeks of preoperative period was considered valid if there were no any factors that affect the hematologic system Descriptive statistics, cross-tabulations and binary logistic regression analysis were performed to identify factors associated withpreoperative anemia. The strength of the association was presented using AOR with 95% confidence interval and p-value < 0.05 was considered as statistically significant.

RESULT

A total of 185 patients enrolled with 100% response rate. We observed preoperative anemia in 36.8% patients. The multi-variable binary logistic analysis showed that ASA II and III [AOR: 3.8, CI: 1.6-9.2], recent prior surgery [AOR: 3.3, CI: 1.3-8.5], history of malignancy [AOR: 9.4, CI: 2.0-43.4], orthopedic procedure [AOR: 11.2, CI: 4.0-31.6] and gynecologic procedure [AOR: 5.2, CI: 1.7-14.5] were significantly associated with preoperative anemia.

CONCLUSION

The prevalence of preoperative anemia was high and ASA ≥2, recent prior surgery, history of malignancy, orthopedic surgery and gynecologic procedure were significantly associated with preoperative anemia. We recommend to clinicians to aim prevention, early detection and treatment of preoperative anemia among adult patients scheduled for major elective surgery to reduce risk of anemia and related adverse outcomes.

Associations between preoperative anaemia and hospital costs following major abdominal surgery: cohort study

Background

Determining the cost-effectiveness and sustainability of patient blood management programmes relies on quantifying the economic burden of preoperative anaemia. This retrospective cohort study aimed to evaluate the hospital costs attributable to preoperative anaemia in patients undergoing major abdominal surgery.

Methods

Patients who underwent major abdominal surgery between 2010 and 2018 were included. The association between preoperative patient haemoglobin (Hb) concentration and hospital costs was evaluated by curve estimation based on the least-square method. The in-hospital cost of index admission was calculated using an activity-based costing methodology. Multivariable regression analysis and propensity score matching were used to estimate the effects of Hb concentration on variables related directly to hospital costs.

Results

A total of 1286 patients were included. The median overall cost was US $18 476 (i.q.r.13 784–27 880), and 568 patients (44.2 per cent) had a Hb level below 13.0 g/dl. Patients with a preoperative Hb level below 9.0 g/dl had total hospital costs that were 50.6 (95 per cent c.i. 14.1 to 98.9) per cent higher than those for patients with a preoperative Hb level of 9.0–13.0 g/dl (P < 0.001), 72.5 (30.6 to 128.0) per cent higher than costs for patients with a Hb concentration of 13.1–15.0 g/dl (P < 0.001), and 62.4 (21.8 to 116.7) per cent higher than those for patients with a Hb level greater than 15.0 g/dl (P < 0.001). Multivariable general linear modelling showed that packed red blood cell (PRBC) transfusions were a principal cost driver in patients with a Hb concentration below 9.0 g/dl.

Conclusion

Patients with the lowest Hb concentration incurred the highest hospital costs, which were strongly associated with increased PRBC transfusions. Costs and possible complications may be decreased by treating preoperative anaemia, particularly more severe anaemia.

Preoperative anemia and surgical outcomes following laparotomy in a resource-limited setting

INTRODUCTION

Anemia is a common and potentially modifiable condition in sub-Saharan Africa. We sought to determine the role of preoperative anemia on post laparotomy abdominal complications.

METHODS

We conducted a six-month prospective, observational study of patients age >12 years following laparotomy at a tertiary hospital in Malawi. The outcome was the occurrence of abdominal complications. Poisson regression analyses estimated the risk of abdominal complications in patients with moderate/severe anemia.

RESULTS

Of 280 patients, most were male (76.4%) with median age of 35 years (IQR 24-50). Abdominal complications developed in 34 patients (15.2%). Of the 224 patients with known preoperative hemoglobin 54 (20.7%) were moderately or severely anemic at the time of surgery. Patients with moderate-to-severe anemia had an increased risk of abdominal complications (RR 4.44, 95% CI 2.0-9.6).

CONCLUSION

Anemia is a common but modifiable comorbidity among laparotomy patients and independently increases the risk of abdominal complications.

RISK FACTORS FOR READMISSION AND LENGTH OF INPATIENT STAY IN RURAL GHANA FOLLOWING EXPLORATORY LAPAROTOMY

BACKGROUND

Increased inpatient length of stay (LOS) and readmission represent significant economic burden on patients and families faced with surgical disease in low-middle income countries given limited surgical access, infrastructure, and variable insurance status.

STUDY AIM

Identify risk factors for readmission and inpatient LOS in postoperative care in the Eastern Regional Hospital, Ghana.

STUDY DESIGN

Retrospective case series.

SETTING

Eastern Regional Hospital, Koforidua, Ghana.

METHODS

Data for exploratory laparotomy procedures were obtained from surgical case logs collected at the regional referral hospital in Koforidua, Eastern Region, Ghana from July 2017 to June 2018. This information was combined with the hospital electronic medical records to collect demographic data, laboratory values, and outcomes. Multivariable analyses were used to model LOS and readmission.

RESULTS

The study included 346 exploratory laparotomy procedures (286 adult, 60 pediatric) for various surgical diseases. The overall 30-day readmission rate was 9.2%. Average LOS was 12.0±20.4 days for readmitted patients and 6.7±5.5 days for patients without readmission. Readmitted patients were more likely to have had preoperative anemia (p=0.009), surgical site infection (P=0.001), or a re-laparotomy (p=0.005). Preoperative anemia (OR=3.5 [95% CI 1.54-7.96], p=0.003) and surgical site infection (OR=3.68 [95% CI 1.36-10.00], p=0.011) were associated with increased odds of readmission. Preoperative anemia was also associated with about 3.0 additional inpatient days (p=0.001).

CONCLUSION

Preoperative anemia and surgical site infections represent risk factors for readmission in rural Ghana. Anemia is also associated with longer LOS. Future interventions aimed at treating anemia and preventing surgical site infections may reduce some of the post-operative burden placed on patients and their families.