AUTHOR=Rumpf Florian , Hof Lotta , Old Oliver , Friederich Patrick , Friedrich Jens , Thoma Josef , Wittmann Maria , Zacharowski Kai , Choorapoikayil Suma , Meybohm Patrick , German Patient Blood Management Network Collaborators , Baumhove Olaf , de Leeuw van Weenen Samuel , Velten Markus , Wittmann Maria , Neumann Claudia , Kirfel Andrea , Straßberger-Nerschbach Nadine , Ehrentraut Heidi , Grigutsch Daniel , Guttenthaler Vera , Puskarevic Alma , Mohssen Ghaith , Görtzen Jan , Narita Diana , Barbara Lighvani , Huber Michael Josef , Blum Valeska Lea , Choorapoikayil Suma , Hof Lotta , Isik Sabine , Neef Vanessa , Piekarski Florian , Zacharowski Kai , Walther Thomas , Keller Harald , Schnitzbauer Andreas , Schmitz-Rixen Thomas , Oikonomou Kyriakos , Steffen Bjoern , Zeuzem Stefan , Czabanka Marcus , Chun Felix , Marzi Ingo , Stöver Timo , Ghanaati Shahram , Louwen Frank , Mueller M. Markus , Geisen Christoph , Seyfried Erhard , Herrmann Eva , Bayer Alexandra , Weigt Henry , Lange Björn , Raadts Ansgar , Haas Christoph , Duemmler Johannes , Lorenzen Ulf , Pagel Matthias , Puehler Thomas , Pochhammer Julius , Klueter Tim , Ahmeti Hajrullah , Bauerschlag Dirk , Wieker Henning , Rusch René , Friedrich Jens , Molter Gerd , Friederich Patrick , Klinik München , Jenke Janina Dana , Kieserling Kira , Scholle Dennie , Steinbicker U. Andrea , Zarbock Alexander , Martens Sven , Schrader Andres , Geissler G. R. , Hillmann H. , Lenz Georg , Schwendner Klaus , Thoma Josef , Weber Viola , Helmer Philipp , Hottenrott Sebastian , Kranke Peter , Meybohm Patrick , Roeder Daniel , Schlesinger Tobias , Sitter Magdalena , Stumpner Jan TITLE=Preoperative hemoglobin thresholds for survival equity in women and men JOURNAL=Frontiers in Medicine VOLUME=11 YEAR=2024 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1334773 DOI=10.3389/fmed.2024.1334773 ISSN=2296-858X ABSTRACT=

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.