Adjusting Current Hemoglobin Thresholds: A Way to Improve Outcome in Women Undergoing Major Surgery

We conducted a study to investigate the impact of haemoglobin (Hb) threshold on postoperative outcomes in women undergoing major surgery. As the World Health Organization Hb threshold for anaemia in women (below 12.0 g/dL) is associated with a higher risk of transfusion, complications and mortality, we aimed to find out whether adjusting these thresholds could improve outcomes.

Therefor, we analysed data from 2,446 patients who underwent major surgery between 2018 and 2019 and divided them into three groups based on their preoperative Hb levels: less than 12.0 g/dL, between 12.0 and 12.9 g/dL, and 13.0 g/dL or higher. We analysed the rate of red blood cell transfusions, postoperative complications and length of hospital stay.

Our results showed that women with an Hb level below 12.0 g/dL had the highest transfusion rate (53%) and a significantly higher incidence of complications such as pneumonia, acute kidney injury and sepsis. They also had longer hospital stays and a higher mortality rate. These results suggest that raising the Hb threshold for defining anaemia in women could reduce complication rates and improve surgical outcomes.

Recommendations

• Our study clearly demonstrates  that Hb values below 12.9 g/dL are associated with an increased probability of foreign blood transfusions and postoperative complications.
• We suggest that raising the Hb threshold for defining anaemia in women could improve postoperative outcomes, supporting calls to revise the WHO anaemia threshold for women.

Cite

Netz A, Hof L, Rumpf F, Blum LV, Neef V, Kerner A, Zacharowski K, Meybohm P, Choorapoikayil S. Adjusting Current Hemoglobin Thresholds: A Way to Improve Outcome in Women Undergoing Major Surgery. J Womens Health (Larchmt). 2024 May;33(5):678-684. doi: 10.1089/jwh.2023.0665. Epub 2024 Mar 26. PMID: 38530069.