In this retrospective analysis of data collected in the American College of Surgeons National Surgical Quality Improvement Program Databases, the authors aimed to determine whether there is an association in neonates between preoperative anaemia and short-term mortality. The study included 2764 consecutive neonates 0-30 days old (70% were term babies, defined by birth after more than 36 weeks of gestation) who underwent a non-cardiac surgery.
The cutoff for anaemia (haematocrit of 40%) was determined using the Youden index. The in-hospital mortality rate in anaemic patients (haematocrit <40%) was 7.5%, compared with 1.4% in non-anaemic participants. Preoperative anaemia remains an independent predictor of in-hospital mortality in a multivariate analysis with adjustment to other risk markers (odds ratio: 2.62; 95% confidence interval: 1.51-4.57). The main limitation of this study is its design: a cause-effect probability cannot be characterised by an observational study. A randomised controlled trial should be done to see if prevention of preoperative anaemia in neonates decreases the risk of short-term mortality after non-cardiac surgery. – Jacques Lacroix