Preoperative anaemia and red blood cell transfusion in patients with aneurysmal subarachnoid and intracerebral haemorrhage - a multicentre subanalysis of the German PBM Network Registry

Acta Neurochir (Wien). 2022 Apr;164(4):985-999. doi: 10.1007/s00701-022-05144-7. Epub 2022 Feb 26.


Purpose: Anaemia is common in patients presenting with aneurysmal subarachnoid (aSAH) and intracerebral haemorrhage (ICH). In surgical patients, anaemia was identified as an idenpendent risk factor for postoperative mortality, prolonged hospital length of stay (LOS) and increased risk of red blood cell (RBC) transfusion. This multicentre cohort observation study describes the incidence and effects of preoperative anaemia in this critical patient collective for a 10-year period.

Methods: This multicentre observational study included adult in-hospital surgical patients diagnosed with aSAH or ICH of 21 German hospitals (discharged from 1 January 2010 to 30 September 2020). Descriptive, univariate and multivariate analyses were performed to investigate the incidence and association of preoperative anaemia with RBC transfusion, in-hospital mortality and postoperative complications in patients with aSAH and ICH.

Results: A total of n = 9081 patients were analysed (aSAH n = 5008; ICH n = 4073). Preoperative anaemia was present at 28.3% in aSAH and 40.9% in ICH. RBC transfusion rates were 29.9% in aSAH and 29.3% in ICH. Multivariate analysis revealed that preoperative anaemia is associated with a higher risk for RBC transfusion (OR = 3.25 in aSAH, OR = 4.16 in ICH, p < 0.001), for in-hospital mortality (OR = 1.48 in aSAH, OR = 1.53 in ICH, p < 0.001) and for several postoperative complications.

Conclusions: Preoperative anaemia is associated with increased RBC transfusion rates, in-hospital mortality and postoperative complications in patients with aSAH and ICH.

Trial registration: , NCT02147795,

Keywords: Anaemia; Aneurysmal subarachnoid haemorrhage; Intracerebral haemorrhage; Patient blood management; Red blood cell transfusion.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Anemia* / complications
  • Anemia* / epidemiology
  • Anemia* / therapy
  • Cerebral Hemorrhage / complications
  • Cerebral Hemorrhage / therapy
  • Erythrocyte Transfusion / adverse effects
  • Humans
  • Registries
  • Streptothricins
  • Subarachnoid Hemorrhage* / complications
  • Subarachnoid Hemorrhage* / diagnosis
  • Subarachnoid Hemorrhage* / therapy


  • phytobacteriomycin
  • Streptothricins

Associated data