The Article by Khaled Musallam and colleagues (Oct 15, p 1396)1 suggests that preoperative anaemia is independently associated with an increased risk of mortality and morbidity. Although the statistical approach is ambitious, there are two points we wish to comment on.First, when studying the demographic data, the following question arises: is preoperative anaemia just a marker of severity of illness or a modifiable risk factor? Anaemic patients had a much higher prevalence of comorbidities, and were more likely to be emergency cases, than those without anaemia. Moreover, 30-6% of patients with severe anaemia had an American Society of Anesthesiologists (ASA) physical status class of IV-V, which was further independently associated with a negative effect on postoperative outcome (adjusted odds ratio 12-7; adjusted odds ratio for anaemia 1-4).
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