The Impact of Preoperative Anemia on Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery at Al-Hussein Teaching Hospital, Samawa, Iraq

Background: Preoperative anemia is a global health issue and noted as an independent risk factor for increased postoperative morbidity and mortality among patients undergoing major surgery. However, there is still a lack of data related to specific preoperative anemia’s impact in low-resource settings in the Middle East and Iraq. The objective of the present study was to evaluate the rate of preoperative anemia, as well as its effects on postoperative outcomes in patients who underwent major abdominal surgery at Al-Hussein Teaching Hospital, Samawa, Iraq. Methods: This was a prospective, observational cohort study conducted over 18 months. Adults undergoing major abdominal surgery were included within the study, and stratified into groups based on whether they were considered as having preoperative anemia as defined by World Health Organization criteria (hemoglobin <13 g/dL for males, <12 g/dL for females). Primary outcomes evaluated were surgical-site infections, pneumonia, acute kidney injury and 30-day mortality, as measured among each of the two groups. Secondary outcomes evaluated were lengths of hospital stay and rates of intensive care unit admissions among the study population. To evaluate any confounding variables, multivariable logistic regression analyses were conducted. Results: Among the 420 patients’ charts reviewed, there were 210 patients (50%) with preoperative anemia. Patients with preoperative anemia experienced a significantly higher rate of complications overall (45.2% vs. 22.4%, p < 0.001), along with significantly greater incidence rates of surgical site infections (18.1% vs. 7.1%, p = 0.001), and significantly longer median lengths of hospital stay (9 days vs. 5 days, p < 0.001). Additionally, the 30-day mortality rate was also significantly higher in the preoperative anemic cohort (6.7% vs. 1.9%, p = 0.021). After adjusting for age, American Society of Anesthesiologists score, malignancy, and operating blood losses, preoperative anemia remained an independent predictor of decreased postoperative outcomes (Adjusted Odds Ratio: 2.45, 95% Confidence Interval: 1.58-3.80, p < 0.001). Conclusions: The current study demonstrates that preoperative anemia is prevalent in Samawa, Iraq, and is associated with being a strong independent predictor of postoperative morbidity and mortality following major abdominal surgery. Therefore, there is an urgent need for implementation of preoperative screenings and patient blood management programs in this area of the world.