Pediatric anesthesia & critical care
Synergistic Association of Prematurity and Preoperative Anemia with Neonatal Postoperative Mortality
Authors' conclusion
Prematurity and preoperative anemia synergistically increase the risk of postoperative mortality in neonates.
Study context
- Population
- Neonates (≤28 days) undergoing noncardiac inpatient surgery, ACS NSQIP-P, 2012–2023
- Participants
- 29,281 neonates
- Exposure
- Preterm and/or anemic vs full-term nonanemic neonates
- Preterm anemicn = 2,853
- Outcome
- Postoperative mortality
- Follow-up
- 30 days
Methodological detailspropensity score weighting, ACS NSQIP-P database
- Propensity score weighting
- ACS NSQIP-P database
Main finding
As reported in the abstract
30-day postoperative mortality
Preterm anemic
12.1%
344 of 2853
Each group vs full-term nonanemicAdjusted relative risk (95% CI)P value
Full-term anemic
1.66(1.31–2.10)
P < 0.001Preterm nonanemic
2.94(2.42–3.58)
P < 0.001Preterm anemic
4.63(3.80–5.64)
P < 0.001- Overall 30-day mortality 932/29,281
- 3.2%
Observational data: associations, not effects.
Further findings
Additive interaction of prematurity and anemia (30-day mortality)
- RERI
- 1.03 (95% CI, 0.29-1.77; P = 0.01)
- Attributable proportion (AP)
- 0.22 (95% CI, 0.08-0.37; P <.01)
- Synergy index (SI)
- 1.40 (95% CI, 1.09-1.79; P = 0.01)
- Indicating significant synergy
Original publication
Synergistic Association of Prematurity and Preoperative Anemia with Neonatal Postoperative Mortality. Anesth Analg. Published 2 June 2026. doi:10.
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