Preoperative anaemia and its impact on immediate surgical outcomes in elderly patients: a multicentre prospective cohort study in Ethiopia

Abstract

OBJECTIVE: To assess how preoperative anaemia affects surgical outcomes in elderly patients within a resource-limited setting. DESIGN: Prospective cohort study. SETTING: Two comprehensive specialised hospitals in Ethiopia. PARTICIPANTS: Participants consisted of 224 patients aged 65 years and older who underwent surgery between 1 December 2024 and 29 March 2025. PRIMARY AND SECONDARY OUTCOME MEASURES: Perioperative blood transfusions were the primary outcome. Secondary outcomes included intensive care unit (ICU) admission, risk of postoperative complications, prolonged hospitalisation, poor recovery quality and in-hospital mortality. RESULTS: The anaemic group required transfusions of three or more units more frequently than the non-anaemic group (10.5% vs 2.6%; absolute risk difference 8.0%). Their perioperative transfusion rates were significantly higher (42.3% vs 18.4%; p<0.001; absolute risk difference 24.0%). This included intraoperative transfusions (31.5% vs 8.1%; p<0.001; absolute risk difference 23.4%) and postoperative transfusions (17.1% vs 9.9%; p=0.007; absolute risk difference 7.2%). Perioperative transfusion was associated with increased risks of in-hospital mortality (Relative Risk [RR]=3.60; 95% CI 2.40 to 6.80), postoperative complications (RR=2.42; 95% CI 1.25 to 4.70), ICU admission (RR=3.89; 95% CI 1.21 to 12.48), extended hospitalisation (RR=2.14; 95% CI 1.15 to 3.97) and poor recovery (RR=2.87; 95% CI 1.54 to 5.36). CONCLUSION AND RECOMMENDATION: Preoperative anaemia significantly increases the risk of transfusion, poor recovery, ICU admission, prolonged hospitalisation and in-hospital mortality in older patients who underwent surgery. In resource-limited settings, improving perioperative outcomes should prioritise the early detection and treatment of anaemia.