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A recent study supported by Vifor Pharma demonstrates that patients with anaemia that undergo a range of non-cardiac surgical procedures have a 42% increased risk of death and a 35% increased risk of serious morbidities compared with patients that are not anaemic.These important results have just been published in the prestigious peer-reviewed medical journal ‘The Lancet’.
Iron deficiency is the most common cause of anaemia worldwide and is considered to be among the most important contributing factors to the global burden of disease, affecting approximately 1.62 billion people (24.8% of the world’s population).1,2 Clinically, anaemia is defined as a condition in which the blood has an abnormally low oxygen-carrying capacity due to a reduction of the number of red blood cells and haemoglobin affecting the normal physiological function of tissues such as blood, brain and muscles.
Iron deficiency anaemia is an important consideration in surgery patients due to the increased risk of negative peri- and postoperative outcomes. Several studies have demonstrated that anaemia is a risk factor for adverse outcomes such as increased mortality and morbidity, blood transfusion during or after the operation (which itself is independently associated with adverse outcomes), infections, and slower recovery requiring a longer stay in hospital.3–6
The authors of The Lancet publication say: "Anaemia could well be present in hundreds of thousands of patients undergoing major non-cardiac surgery each year.”
They analysed data from 227,425 patients in the ACS NSQIP database, with the aim to determine whether preoperative anaemia affected 30-day postoperative morbidity and mortality in patients undergoing major non-cardiac surgery.
Thirty percent (69,229 patients) of patients in this study had preoperative anaemia. Postoperative mortality at 30 days was 42% higher in the patients with anaemia than in those without anaemia. This increased risk was consistent for mild anaemia (41%) and moderate-to-severe anaemia (44%).
Patients with anaemia were also 35% more likely to have one or more of the studied postoperative morbidities which were cardiac, respiratory, CNS, urinary tract, wound, sepsis, and venous thromboembolic occurrences. This increased risk was again seen in patients with mild anaemia (31% increased risk) and moderate-to-severe anaemia (56% increased risk).
When compared with patients without anaemia or a defined risk factor, patients with anaemia and one or more risk factors (for example age ≥65 years, cardiac disease, renal disease, cancer, severe chronic obstructive pulmonary disease, CNS disease, or systemic sepsis) had a higher adjusted odds ratio for 30-day mortality and morbidity than did patients with either anaemia or the risk factor alone.
The authors conclude that this study should lead to careful assessment, early detection, and treatment of preoperative anaemia to reduce adverse postoperative outcomes, at least in elective surgery. “We hope that our findings will not only increase awareness towards the debilitating effects of preoperative anaemia, but also stimulate further research to identify the optimal management approach.”
The Lancet online publication is available on the internet under the following link: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61381-0/abstract
1. WHO, CDC. Worldwide prevalence of anaemia 1993–2005. WHO global database on anaemia. Geneva: WHO, CDC, 2008
2. Stoltzfus RJ, Mullany L, Black RE. Iron deficiency anaemia. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL (Eds). Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. WHO, 2004
3. Beattie AS et al. Anesthesiology 2009;110:574–81
4. Myers E et al. Arch Orthop Trauma Surg 2004;124:699–701
5. Gruson KI et al. J Ortho Trauma 2002;16:39–44
6. Wu W-C et al. JAMA 2007;297:2481–8
Vifor Pharma, a company of the Galenica Group, is a world leader in the discovery, development, manufacturing and marketing of pharmaceutical products for the treatment of iron deficiency. The company also offers a diversified portfolio of prescription medicines as well as over-the-counter (OTC) products. Vifor Pharma, headquartered in Zurich, Switzerland, has an increasingly global presence and a broad network of affiliates and partners around the world.
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