☆ 4.6 Article

Association between postoperative haemoglobin concentrations and composite of non-fatal myocardial infarction and all-cause mortality in noncardiac surgical patients: post hoc analysis of the POISE-2 trial

BRITISH JOURNAL OF ANAESTHESIA (2021)

Journal

BRITISH JOURNAL OF ANAESTHESIA

Volume 126, Issue 1, Pages 87-93

Publisher

ELSEVIER SCI LTD

DOI: 10.1016/j.bja.2020.08.054

Keywords

anaemia; anaesthesia; cardiovascular risk; haemoglobin; myocardial infarction; postoperative outcomes risk; surgery

Funding

Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
Canadian Institutes of Health Research
American Physicians Fellowship for Medicine in Israel
Instituto de Salud Carlos III [BA18/00048]

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Abstract

A retrospective analysis of 7227 patients from the POISE-2 trial found that postoperative anaemia may be a modifiable risk factor for non-fatal myocardial infarction and all-cause mortality, especially in patients with lower postoperative haemoglobin concentrations.

Background: Myocardial infarction is the most common postoperative major vascular complication. Perioperative anaemia may contribute to cardiac supply-demand mismatch, and therefore myocardial injury. We therefore tested the hypothesis that the lowest in-hospital postoperative haemoglobin concentration is associated with a composite of non-fatal myocardial infarction and all-cause mortality within the first 30 days after noncardiac surgery. Methods: We conducted a retrospective analysis of patients enrolled in the PeriOperative Ischemic Evaluation-2 (POISE-2) trial. We assessed the association between the lowest postoperative haemoglobin concentration during the initial hospitalisation and a composite of non-fatal myocardial infarction (Third Universal Definition) and all-cause mortality within 30 postoperative days, using a multivariable logistic regression model. Results: We analysed 7227 patients from POISE-2, of whom 7.8% developed myocardial infarction; 1.5% died within 30 days. The composite primary outcome of non-fatal myocardial infarction and all-cause mortality occurred in 8.9% patients overall, ranging from 16% in patients with postoperative haemoglobin concentrations <88 g L (-1) to 4.1% in patients with postoperative haemoglobin >113 g L (-1). After adjusting for baseline factors, in patients with a lowest postoperative haemoglobin concentration <110 g L (-1), each 10 g L (-1) reduction in the lowest postoperative haemoglobin concentration was associated with a 1.46 (95% confidence interval: 1.37-1.56; P<0.001) fold increase in the odds of the composite outcome. In contrast, there was no significant relationship amongst patients with lowest postoperative haemoglobin concentration >110 g L (-1). Conclusions: Postoperative anaemia may be a modifiable risk factor for non-fatal myocardial infarction and all-cause mortality.

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Postoperative anaemia and patient-centred outcomes after major abdominal surgery: a retrospective cohort study

Paul S. Myles, Toby Richards, Andrew Klein, Erica M. Wood, Sophie Wallace, Mark A. Shulman, Catherine Martin, Rinaldo Bellomo, Tomas B. Corcoran, Philip J. Peyton, David A. Story, Kate Leslie, Andrew Forbes

Summary: This study investigated the impact of postoperative anaemia and its association with poor outcomes after surgery. The results showed that postoperative anaemia was associated with increased risk of death or disability, septic complications, longer hospital stays, and lower quality of recovery.

BRITISH JOURNAL OF ANAESTHESIA (2022)