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Preoperative Anemia and Perioperative Outcomes in Children: Prevalence, Risk Factors, and Associations in an
Matthew Hart1,2, Alexandra Batinic2,3, Justin Skowno1,2
1Department of Anaesthesia, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Insights
Preoperative anemia affects one in five children undergoing major surgery, increasing risks for red blood cell transfusion and infection. Early identification and management are crucial for pediatric surgical patients.
Area of Science:
- Pediatric Surgery
- Hematology
- Anesthesia
Background:
- Preoperative anemia is a modifiable risk factor in pediatric surgery.
- Limited contemporary data exists on its prevalence and outcomes in high-income countries.
Purpose of the Study:
- Determine anemia prevalence in pediatric major surgery patients.
- Identify associated demographic and clinical factors.
- Examine associations with perioperative outcomes.
Main Methods:
- Retrospective observational study of 582 children undergoing major surgery in Australia.
- Anemia defined by WHO 2024 thresholds.
- Logistic regression analyzed associations with transfusion and infection.
Main Results:
- Anemia prevalence was 21.1%, more common in females, higher ASA classification, emergency surgery, and comorbidities.
- Anemia independently associated with red cell transfusion (aOR 2.77) and postoperative infection (aOR 1.89).
- Anemia common even in elective cases, highlighting screening potential.
Conclusions:
- Preoperative anemia affects one in five pediatric surgical patients, linked to transfusion and infection.
- Findings support strategies for anemia identification and management.
- Prevalence and outcome associations may be influenced by missing preoperative data.
Aims:
Preoperative anemia is a potentially modifiable risk factor in children undergoing surgery, but contemporary data describing its prevalence and associated outcomes in high-income settings are limited. We aimed to determine the prevalence of anemia in a pediatric major-surgery surgical cohort, identify associated demographic and clinical factors, and examine relationships with perioperative outcomes.
Methods:
We conducted a retrospective observational study of children undergoing major surgery at an Australian tertiary children's hospital. Patients with a hemoglobin measurement within 3 months prior to surgery were included. Anemia was defined according to the World Health Organization 2024 thresholds. Demographic variables, comorbidities, surgical characteristics, transfusion, and postoperative outcomes were extracted. Logistic regression was used to evaluate independent associations between preoperative anemia, red cell transfusion, and postoperative infection.
Results:
Of 786 eligible patients, 582 (74%) were included. Anemia was present in 123 children (21.1%, 95% CI 18.0-24.6). Anemia was more common in females, higher ASA classification, emergency surgery, and those with chronic comorbidities. In multivariable analyses, anemia was independently associated with red cell transfusion (aOR 2.77, 95% CI 1.74-4.41), and with postoperative infection (aOR 1.89, 95% CI 1.15-3.09). Other postoperative outcomes were not significantly associated with preoperative anemia. Anemia remained common in elective surgical patients, a group in whom preoperative screening and optimization are feasible.
Conclusion:
Preoperative anemia affects one in five children undergoing major surgery in this Australian cohort and is independently associated with red cell transfusion and postoperative infection. These findings support further evaluation of strategies to identify and manage preoperative anemia in pediatric surgical patients. The observed prevalence and outcome associations in this cohort should be interpreted in the context of missing preoperative hemoglobin data, which may bias estimates toward higher risk patients.
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