Frontiers in Medicine (Mar 2024)

Preoperative hemoglobin thresholds for survival equity in women and men

  • Florian Rumpf,
  • Lotta Hof,
  • Oliver Old,
  • Patrick Friederich,
  • Jens Friedrich,
  • Josef Thoma,
  • Maria Wittmann,
  • Kai Zacharowski,
  • Suma Choorapoikayil,
  • Patrick Meybohm,
  • German Patient Blood Management Network Collaborators,
  • Olaf Baumhove,
  • Samuel de Leeuw van Weenen,
  • Markus Velten,
  • Maria Wittmann,
  • Claudia Neumann,
  • Andrea Kirfel,
  • Nadine Straßberger-Nerschbach,
  • Heidi Ehrentraut,
  • Daniel Grigutsch,
  • Vera Guttenthaler,
  • Alma Puskarevic,
  • Ghaith Mohssen,
  • Jan Görtzen,
  • Diana Narita,
  • Lighvani Barbara,
  • Michael Josef Huber,
  • Valeska Lea Blum,
  • Suma Choorapoikayil,
  • Lotta Hof,
  • Sabine Isik,
  • Vanessa Neef,
  • Florian Piekarski,
  • Kai Zacharowski,
  • Thomas Walther,
  • Harald Keller,
  • Andreas Schnitzbauer,
  • Thomas Schmitz-Rixen,
  • Kyriakos Oikonomou,
  • Bjoern Steffen,
  • Stefan Zeuzem,
  • Marcus Czabanka,
  • Felix Chun,
  • Ingo Marzi,
  • Timo Stöver,
  • Shahram Ghanaati,
  • Frank Louwen,
  • M. Markus Mueller,
  • Christoph Geisen,
  • Erhard Seyfried,
  • Eva Herrmann,
  • Alexandra Bayer,
  • Henry Weigt,
  • Björn Lange,
  • Ansgar Raadts,
  • Christoph Haas,
  • Johannes Duemmler,
  • Ulf Lorenzen,
  • Matthias Pagel,
  • Thomas Puehler,
  • Julius Pochhammer,
  • Tim Klueter,
  • Hajrullah Ahmeti,
  • Dirk Bauerschlag,
  • Henning Wieker,
  • René Rusch,
  • Jens Friedrich,
  • Gerd Molter,
  • Patrick Friederich,
  • München Klinik,
  • Janina Dana Jenke,
  • Kira Kieserling,
  • Dennie Scholle,
  • U. Andrea Steinbicker,
  • Alexander Zarbock,
  • Sven Martens,
  • Andres Schrader,
  • G. R. Geissler,
  • H. Hillmann,
  • Georg Lenz,
  • Klaus Schwendner,
  • Josef Thoma,
  • Viola Weber,
  • Philipp Helmer,
  • Sebastian Hottenrott,
  • Peter Kranke,
  • Patrick Meybohm,
  • Daniel Roeder,
  • Tobias Schlesinger,
  • Magdalena Sitter,
  • Jan Stumpner

DOI
https://doi.org/10.3389/fmed.2024.1334773
Journal volume & issue
Vol. 11

Abstract

Read online

Anemia affects humans throughout life, and is linked to higher morbidity and mortality. Unclear is whether hemoglobin values are equivalent between women and men. This study evaluates the association of preoperative hemoglobin levels with in-hospital mortality and estimates thresholds for survival equity between men and women. All adult patients undergoing surgery between 2010 and 2019 from 14 German hospitals were included in the study. Thresholds for survival equity were determined with generalized additive models. In total, 842,130 patients with a median in-hospital follow-up time of 7 days were analyzed. During follow-up 20,370 deaths occurred. Preoperative hemoglobin stratified in-hospital mortality (log-rank test p < 0.001) and was associated with mortality independently of demographic risk, surgical risk and health status. For each 1 g/dL reduction in preoperative hemoglobin, the odds of mortality increased by a factor of 1.22 (95% CI 1.21–1.23, p < 0.001). A preoperative hemoglobin threshold of 10.5 g/dL reflected equivalent risk for both male and female patients. Hemoglobin levels below 10.5 g/dL had higher risk of mortality for women than for men. The findings from this study aid evidence-based thresholds, inform anemia management and promote equitable care, thus enhancing patient outcomes.

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