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BMJ 2011; 343 doi: (Published 12 October 2011) Cite this as: BMJ 2011;343:d6476

More complications and higher mortality for surgical patients with preoperative anaemia

A large observational study confirms that surgical patients with preoperative anaemia do significantly worse than those with a normal packed cell volume. Any preoperative anaemia was associated with a 42% increase in the risk of death within 30 days (odds ratio 1.42, 95% CI 1.31 to 1.54) among nearly a quarter of a million adults who had surgery in 2008. Even mild preoperative anaemia was also associated with a 31% increase in the risk of serious postoperative morbidity (1.35, 1.26 to 1.36). Both associations looked independent. The authors adjusted for more than 60 other factors that might influence outcome, including large perioperative transfusions.

The authors interrogated an international database of surgical patients, administered by the American College of Surgeons, as part of a quality improvement programme. They included patients having any elective or emergency operation except those having cardiac surgery, transplant surgery, or surgery for trauma. Around a third of the participants had preoperative anaemia (69 229/227 425, 30.4%), which was mostly mild (packed cell volume between 0.29 and 0.39 for men and between 0.29 and 0.36 for women). The study was sponsored by Vifor Pharma, a company that specialises in iron replacement therapy.

The link between preoperative anaemia and a higher risk of death or complications after all kinds of surgery is now established, say the authors, and some guidelines already recommend identifying and treating anaemia preoperatively. Just how that should be done isn’t yet clear, however, and won’t be clear until researchers move on from retrospective observation to prospective clinical trials.

Antenatal diethylstilboestrol casts a long shadow

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Diethylstilboestrol was originally thought to prevent the complications of pregnancy, and millions of pregnant women were treated before the drug was discredited in the 1970s. Diethylstilboestrol is famously linked to rare adenocarcinomas of the …

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