Faculty Collaboration Database

Reassessing anaemia in gastrectomy: Diagnostic definitions and predictive value in the POWER 4 cohort. Rev Esp Anestesiol Reanim (Engl Ed) 2026 Feb;73(2):502020

Date

02/02/2026

Pubmed ID

41621750

DOI

10.1016/j.redare.2026.502020

Abstract

BACKGROUND: Preoperative anaemia is a common finding in patients undergoing gastrectomy, and is frequently targeted in optimisation strategies. However, its independent association with postoperative complications remains unclear, and the prognostic value of redefining diagnostic thresholds has not been formally assessed.

METHODS: This prospective substudy of the POWER 4 cohort included 742 patients undergoing elective gastrectomy for cancer. Anaemia was defined by WHO sex-specific thresholds (Hb <13 g/dL in men, <12 g/dL in women) and a universal threshold of <13 g/dL. Four subcohorts were analysed: A1 (WHO, full cohort), A2 (universal, full), B1 (WHO, untreated), B2 (universal, untreated). Multivariable logistic regression was used to assess associations with postoperative complications. Discrimination was evaluated using AUC, AIC/BIC, and Net Reclassification Improvement (NRI). Generalised additive models (GAMs) were used to explore continuous relationships between haemoglobin and risk.

RESULTS: Anaemia prevalence was 38.0% with WHO thresholds and 52.4% with the universal threshold. In full-cohort models, anaemia was not independently associated with complications (A1 OR 0.92 [95% CI 0.60-1.41]; A2 OR 0.89 [0.59-1.36]). Model performance was similar (AUC 0.686). In untreated patients (n = 584), discrimination improved (B1 AUC 0.750; B2 AUC 0.743), but anaemia remained non-significant. NRI modestly favoured the universal threshold (A1/A2: 0.048; B1/B2: 0.072), with most reclassification occuring in intermediate risk groups. GAMs showed a smooth monotonic relationship without a clear inflection point.

CONCLUSION: Anaemia was not independently associated with postoperative complications. Redefining thresholds altered prevalence but did not improve prediction. Haemoglobin may be better used as part of an integrated perioperative risk assessment rather than a binary stratifier.

Author List

Ripolles-Melchor J, Abad-Motos A, Nieto Moreno E, Jerico C, Otero-Martínez I, Abdel-Lah Fernández O, García-Alvarez R, Tormos-Pérez MP, Espinosa AV, Aldecoa C, Abad-Gurumeta A, Colomina MJ, García-Erce JA, POWER 4 Investigators Group

Author

Angel Vicente Espinosa MD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Anemia
Cohort Studies
Female
Gastrectomy
Hemoglobins
Humans
Male
Middle Aged
Postoperative Complications
Predictive Value of Tests
Prevalence
Prospective Studies
Stomach Neoplasms