The Association of Preoperative Hemoglobin and Adverse Outcomes in Elective Surgical Procedures: A Retrospective Review.

Abstract

Anemia is characterized by a decrease in the oxygen-carrying capacity of red blood cells. This condition negatively affects perioperative patients and surgical outcomes. Strategies to manage anemia prior to elective surgeries are needed to improve patient outcomes. To provide additional evidence that preoperative anemia is associated with increased blood utilization and adverse outcomes in patients undergoing major elective surgical procedures. A retrospective chart review of major elective surgical procedures at a large urban health care system during January 2024 was performed. One hundred thirty patient charts were reviewed. Patients were categorized into 2 groups: those who were transfused intraoperatively or postoperatively and those who were not transfused. Variables of interest included age, sex, length of stay, American Society of Anesthesiologists Physical Status classification, estimated blood loss and preoperative hemoglobin values, and intraoperative or postoperative blood product utilization. Associations between variables were determined via χ2, point biserial, and Pearson correlation analysis. There was a significant negative relationship between preoperative hemoglobin level and transfusion (-0.45; P < .001) and a significant positive relationship between hemoglobin level and length of stay (0.34; P < .001). Patients who were transfused intraoperatively or postoperatively had a lower average preoperative hemoglobin level (10.1 g/dL versus 12.5 g/dL; P < .001). Patients with lower preoperative hemoglobin levels had an increased predicted probability of transfusion and a longer length of stay. Our results show that preoperative anemia is associated with higher intraoperative or postoperative blood utilization and longer hospitalization. Preoperative anemia clinics and patient blood management programs are strategies that can be used to improve clinical outcomes.