Perioperative Hemoglobin Trajectory and Hemoglobin Decrease in Major Abdominal Surgery

Most studies evaluate perioperative hemoglobin at a single time point despite substantial changes across the perioperative period. We examined whether perioperative hemoglobin trajectory and perioperative hemoglobin decrease were associated with postoperative outcomes after major abdominal surgery.

We performed a secondary analysis of the international POSTVenTT cohort, a prospective multicentre observational study of adults undergoing major abdominal surgery. Hemoglobin trajectory was defined according to anemia status preoperatively and at hospital discharge. Perioperative hemoglobin decrease was defined as the difference between preoperative and discharge hemoglobin concentration. Mixed-effects logistic regression models adjusted for predefined clinical covariates and center clustering were used to evaluate associations with postoperative complications, postoperative transfusion, and 30-day readmission.

Among 5302 patients, 3735 had both preoperative and discharge hemoglobin measurements and were included in trajectory analyses. Compared with patients without perioperative anemia, persistent anemia was associated with the higher odds of postoperative complications, postoperative transfusion, and 30-day readmission, whereas new postoperative anemia showed similar but smaller associations. Greater perioperative hemoglobin decrease was associated with higher odds of postoperative complications. For each 10 g/L decrease, the odds of any postoperative complication increased by 35% (OR 1.35, 95% CI 1.26-1.45) and major complication by 49% (OR 1.49, 1.35-1.64). Associations persisted after accounting for transfusion exposure and baseline hemoglobin.

Perioperative hemoglobin trajectory and perioperative hemoglobin decrease were associated with postoperative complications and 30-day readmission after major abdominal surgery. Greater hemoglobin decrease remained associated with adverse outcomes after accounting for transfusion exposure and baseline hemoglobin.

The POSTVenTT study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621001517864; 8 November 2021). The trial protocol was approved by the South Metropolitan Health Service (Western Australia) Health Research Ethics Committee (EC00265), the Western Australia Research Governance System (RCG 4477), with local ethics and governance confirmed at each site before patient recruitment.