Effect of perioperative blood transfusion on preoperative haemoglobin levels as a risk factor for long-term outcomes in patients undergoing major noncardiac surgery: a prospective multicentre observational study

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2024-10-16 DOI:10.1016/j.bja.2024.09.007

Fraser J.D. Morris , Rasmus Åhman , Alison Craswell , Helén Didriksson , Carina Jonsson , Manda Gisselgård , Henrik A. Andersson , Yoke-Lin Fung , Michelle S. Chew

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Abstract

Background

Preoperative anaemia and red blood cell (RBC) transfusions are associated with poorer clinical outcomes. It is unknown whether perioperative RBC transfusions mediate the relationship between preoperative haemoglobin levels and postoperative outcomes.

Methods

This was a prospective observational study among patients aged ≥50 yr undergoing elective major noncardiac surgery from four Swedish hospitals. The co-primary outcomes were 1-yr major adverse cardiovascular and cerebrovascular events (MACCEs) and all-cause mortality. The secondary outcome was a composite of 30-day mortality, MACCEs, acute kidney injury (AKI), pulmonary embolism, anastomotic leak, and postoperative infection. Mediation analyses were conducted with preoperative haemoglobin as the exposure and RBC transfusion as a mediator.

Results

Among 1060 patients (mean age 70 [SD 9] yr; 472 [45%] women), 171 patients (16.1%) developed 1-yr MACCEs, and 105 patients (9.9%) died within 1 yr. Preoperative haemoglobin levels were significantly associated with both 1-yr MACCEs (b=–0.015, P=0.041) and all-cause mortality (b=–0.028, P<0.001). Volume of RBC transfusion was not directly associated with the outcomes and did not mediate the relationship between preoperative haemoglobin levels and 1-yr MACCEs (b=–0.001, P=0.451) or all-cause mortality (b=–0.002, P=0.293). For the secondary outcome, RBC transfusions had a significant mediating effect between preoperative haemoglobin and the composite 30-day outcome; however, no direct association was observed (b=0.006, P=0.554).

Conclusions

Preoperative haemoglobin levels were significantly associated with 1-yr MACCEs and all-cause mortality. This effect was not mediated by perioperative RBC transfusions. Further research is needed to confirm these findings.

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围手术期输血对术前血红蛋白水平的影响是非心脏大手术患者长期预后的风险因素：一项前瞻性多中心观察研究。

背景术前贫血和输注红细胞（RBC）与较差的临床预后有关。本文是一项前瞻性观察研究，研究对象是瑞典四家医院中年龄≥50 岁、接受择期非心脏大手术的患者。共同主要结果为1年主要不良心脑血管事件（MACCE）和全因死亡率。次要结果是30天死亡率、MACCEs、急性肾损伤（AKI）、肺栓塞、吻合口漏和术后感染的综合结果。结果在 1060 名患者（平均年龄 70 [SD 9] 岁；女性 472 [45%]）中，171 名患者（16.1%）在 1 年内出现 MACCE，105 名患者（9.9%）在 1 年内死亡。术前血红蛋白水平与 1 年 MACCEs（b=-0.015，P=0.041）和全因死亡率（b=-0.028，P<0.001）显著相关。输注红细胞的量与结果没有直接关系，也没有调节术前血红蛋白水平与 1 年 MACCEs（b=-0.001，P=0.451）或全因死亡率（b=-0.002，P=0.293）之间的关系。对于次要结局，输注红细胞在术前血红蛋白与 30 天综合结局之间具有显著的中介效应；但未观察到直接关联（b=0.006，P=0.554）。这种影响与围手术期输注红细胞无关。需要进一步的研究来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.