Association of Preoperative Anemia with Postoperative Mortality in Neonates

SM Goobie, D Faraoni, D Zurakowski,  JA. DiNardo

Jama Peds. Sept 2016.

Purpose: To assess the association between preoperative anemia and postoperative mortality in neonates undergoing non-cardiac surgery in a large sample of US hospitals. In adults anemia is a strong independent risk factor for postoperative mortality. This relationship had not been investigated in neonates.

Objective: Data from the 2012 and 2013 pediatric databases of the American College of Surgeons National Surgical Quality Improvement Program was used to conduct a retrospective study of neonates undergoing non-cardiac surgery. All neonates (0-30 days old) with a recorded preoperative hematocrit value were included. They defined anemia as a hematocrit level of less than 40%.

Results: Neonates accounted for 2764 children (6%) in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program databases. Neonates in the study were predominately male (64.5%), white (66.3%), and term (69.9% greater than 36 weeks’ gestation) and weighed more than 2 kg (85.0%). Postoperative in-hospital mortality was 3.4% in neonates compared to 0.6% in all age groups (0-18 years). Multivariable regression analysis demonstrated that preoperative anemia is an independent risk factor for mortality (OR, 2.62; 95%CI, 1.51-4.57) in neonates. The prevalence of postoperative in-hospital mortality was significantly higher in neonates with a preoperative hematocrit level less than 40%; being 7.5% (95%CI, 1%-10%) vs 1.4%(95%CI,0%-4%) for preoperative hematocrit levels 40%, or greater.

Conclusion: This is the first study to define the incidence of anemia in neonates in US hospitals, define the incidence of neonatal anemia and identify a strong independent association between preoperative anemia and postoperative neonatal mortality. Preoperative anemia could potentially be a marker for severity of illness leading to increased risk for mortality in neonates needing surgery. We need to develop a better understanding of how the timely diagnosis, prevention, and appropriate treatment of preoperative anemia in neonates could improve survival.