Associations of nadir haemoglobin level and red blood cell transfusion with mortality and length of stay in surgical specialties: a retrospective cohort study

K. M. Trentino, M. F. Leahy, F. M. Sanfilippo, S. L. Farmer, A. Hofmann, H. Mace, K. Murray

Research output: Contribution to journalArticle

Abstract

Few studies have investigated if, and how, red cell transfusion and anaemia interact. We analysed 60,955 admissions to three metropolitan hospitals in Western Australia between 2008 and 2017 to determine whether the relationship between red cell transfusion and outcomes in surgical patients differed by lowest (nadir) level of haemoglobin. At levels above 100 g.l −1 , in-hospital, 30-day and 1-year mortality were higher with transfusion, the adjusted odds ratios (ORs) (95%CI) being 8.80 (4.43–17.45) p < 0.001 and 3.68 (1.93–7.02) p < 0.001 and the adjusted hazard ratio (95%CI) being 1.83 (1.28–2.61) p = 0.001, respectively. Likewise, between 90 g.l −1 and 99 g.l −1 , in-hospital, 30-day and 1-year mortality were higher with transfusion, the adjusted odds ratio (95%CI) being 3.76 (2.23–6.34) p < 0.001 and 1.96 (1.23–3.12) p < 0.001 and the adjusted hazard ratio (95%CI) being 1.34 (1.05–1.70) p = 0.017, respectively. Length of stay was longer with transfusion at nadir haemoglobin levels above 100 g.l −1 and in the following ranges: 90–99 g.l −1 , 80–89 g.l −1 , 70–79 g.l −1 and 60–69 g.l −1 , the adjusted rate ratio (95%CI) being 1.38 (1.25–1.53) p < 0.001, 1.18 (1.10–1.27) p < 0.001, 1.17 (1.13–1.22) p < 0.001, 1.07 (1.02–1.12) p = 0.003 and 1.24 (1.13–1.36) p < 0.001, respectively. Mortality was higher with red cell transfusion at haemoglobin levels greater than 90 g.l −1 , whereas at all levels below 90 g.l −1 mortality was not significantly higher or lower. Length of stay was longer with transfusion at nadir haemoglobin levels of 60 g.l −1 or above. Our results suggest that nadir haemoglobin modified the relationship between red cell transfusion and outcomes and adds to the evidence recommending caution before transfusing red cells.

Original languageEnglish
Pages (from-to)726-734
Number of pages9
JournalAnaesthesia
Volume74
Issue number6
DOIs
Publication statusPublished - 1 Jun 2019

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Surgical Specialties
Erythrocyte Transfusion
Length of Stay
Hemoglobins
Cohort Studies
Retrospective Studies
Mortality
Odds Ratio
Western Australia
Urban Hospitals
Anemia

Cite this

@article{32d15fbba8d54631a210e59ed60ec1fe,
title = "Associations of nadir haemoglobin level and red blood cell transfusion with mortality and length of stay in surgical specialties: a retrospective cohort study",
abstract = "Few studies have investigated if, and how, red cell transfusion and anaemia interact. We analysed 60,955 admissions to three metropolitan hospitals in Western Australia between 2008 and 2017 to determine whether the relationship between red cell transfusion and outcomes in surgical patients differed by lowest (nadir) level of haemoglobin. At levels above 100 g.l −1 , in-hospital, 30-day and 1-year mortality were higher with transfusion, the adjusted odds ratios (ORs) (95{\%}CI) being 8.80 (4.43–17.45) p < 0.001 and 3.68 (1.93–7.02) p < 0.001 and the adjusted hazard ratio (95{\%}CI) being 1.83 (1.28–2.61) p = 0.001, respectively. Likewise, between 90 g.l −1 and 99 g.l −1 , in-hospital, 30-day and 1-year mortality were higher with transfusion, the adjusted odds ratio (95{\%}CI) being 3.76 (2.23–6.34) p < 0.001 and 1.96 (1.23–3.12) p < 0.001 and the adjusted hazard ratio (95{\%}CI) being 1.34 (1.05–1.70) p = 0.017, respectively. Length of stay was longer with transfusion at nadir haemoglobin levels above 100 g.l −1 and in the following ranges: 90–99 g.l −1 , 80–89 g.l −1 , 70–79 g.l −1 and 60–69 g.l −1 , the adjusted rate ratio (95{\%}CI) being 1.38 (1.25–1.53) p < 0.001, 1.18 (1.10–1.27) p < 0.001, 1.17 (1.13–1.22) p < 0.001, 1.07 (1.02–1.12) p = 0.003 and 1.24 (1.13–1.36) p < 0.001, respectively. Mortality was higher with red cell transfusion at haemoglobin levels greater than 90 g.l −1 , whereas at all levels below 90 g.l −1 mortality was not significantly higher or lower. Length of stay was longer with transfusion at nadir haemoglobin levels of 60 g.l −1 or above. Our results suggest that nadir haemoglobin modified the relationship between red cell transfusion and outcomes and adds to the evidence recommending caution before transfusing red cells.",
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Associations of nadir haemoglobin level and red blood cell transfusion with mortality and length of stay in surgical specialties : a retrospective cohort study. / Trentino, K. M.; Leahy, M. F.; Sanfilippo, F. M.; Farmer, S. L.; Hofmann, A.; Mace, H.; Murray, K.

In: Anaesthesia, Vol. 74, No. 6, 01.06.2019, p. 726-734.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Associations of nadir haemoglobin level and red blood cell transfusion with mortality and length of stay in surgical specialties

T2 - a retrospective cohort study

AU - Trentino, K. M.

AU - Leahy, M. F.

AU - Sanfilippo, F. M.

AU - Farmer, S. L.

AU - Hofmann, A.

AU - Mace, H.

AU - Murray, K.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Few studies have investigated if, and how, red cell transfusion and anaemia interact. We analysed 60,955 admissions to three metropolitan hospitals in Western Australia between 2008 and 2017 to determine whether the relationship between red cell transfusion and outcomes in surgical patients differed by lowest (nadir) level of haemoglobin. At levels above 100 g.l −1 , in-hospital, 30-day and 1-year mortality were higher with transfusion, the adjusted odds ratios (ORs) (95%CI) being 8.80 (4.43–17.45) p < 0.001 and 3.68 (1.93–7.02) p < 0.001 and the adjusted hazard ratio (95%CI) being 1.83 (1.28–2.61) p = 0.001, respectively. Likewise, between 90 g.l −1 and 99 g.l −1 , in-hospital, 30-day and 1-year mortality were higher with transfusion, the adjusted odds ratio (95%CI) being 3.76 (2.23–6.34) p < 0.001 and 1.96 (1.23–3.12) p < 0.001 and the adjusted hazard ratio (95%CI) being 1.34 (1.05–1.70) p = 0.017, respectively. Length of stay was longer with transfusion at nadir haemoglobin levels above 100 g.l −1 and in the following ranges: 90–99 g.l −1 , 80–89 g.l −1 , 70–79 g.l −1 and 60–69 g.l −1 , the adjusted rate ratio (95%CI) being 1.38 (1.25–1.53) p < 0.001, 1.18 (1.10–1.27) p < 0.001, 1.17 (1.13–1.22) p < 0.001, 1.07 (1.02–1.12) p = 0.003 and 1.24 (1.13–1.36) p < 0.001, respectively. Mortality was higher with red cell transfusion at haemoglobin levels greater than 90 g.l −1 , whereas at all levels below 90 g.l −1 mortality was not significantly higher or lower. Length of stay was longer with transfusion at nadir haemoglobin levels of 60 g.l −1 or above. Our results suggest that nadir haemoglobin modified the relationship between red cell transfusion and outcomes and adds to the evidence recommending caution before transfusing red cells.

AB - Few studies have investigated if, and how, red cell transfusion and anaemia interact. We analysed 60,955 admissions to three metropolitan hospitals in Western Australia between 2008 and 2017 to determine whether the relationship between red cell transfusion and outcomes in surgical patients differed by lowest (nadir) level of haemoglobin. At levels above 100 g.l −1 , in-hospital, 30-day and 1-year mortality were higher with transfusion, the adjusted odds ratios (ORs) (95%CI) being 8.80 (4.43–17.45) p < 0.001 and 3.68 (1.93–7.02) p < 0.001 and the adjusted hazard ratio (95%CI) being 1.83 (1.28–2.61) p = 0.001, respectively. Likewise, between 90 g.l −1 and 99 g.l −1 , in-hospital, 30-day and 1-year mortality were higher with transfusion, the adjusted odds ratio (95%CI) being 3.76 (2.23–6.34) p < 0.001 and 1.96 (1.23–3.12) p < 0.001 and the adjusted hazard ratio (95%CI) being 1.34 (1.05–1.70) p = 0.017, respectively. Length of stay was longer with transfusion at nadir haemoglobin levels above 100 g.l −1 and in the following ranges: 90–99 g.l −1 , 80–89 g.l −1 , 70–79 g.l −1 and 60–69 g.l −1 , the adjusted rate ratio (95%CI) being 1.38 (1.25–1.53) p < 0.001, 1.18 (1.10–1.27) p < 0.001, 1.17 (1.13–1.22) p < 0.001, 1.07 (1.02–1.12) p = 0.003 and 1.24 (1.13–1.36) p < 0.001, respectively. Mortality was higher with red cell transfusion at haemoglobin levels greater than 90 g.l −1 , whereas at all levels below 90 g.l −1 mortality was not significantly higher or lower. Length of stay was longer with transfusion at nadir haemoglobin levels of 60 g.l −1 or above. Our results suggest that nadir haemoglobin modified the relationship between red cell transfusion and outcomes and adds to the evidence recommending caution before transfusing red cells.

KW - anaemia

KW - red cell transfusion

KW - treatment outcome

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U2 - 10.1111/anae.14636

DO - 10.1111/anae.14636

M3 - Article

VL - 74

SP - 726

EP - 734

JO - Anaesthesia

JF - Anaesthesia

SN - 0003-2409

IS - 6

ER -