Association of preoperative red blood cell width and postoperative 30-day mortality in patients undergoing non-cardiac surgery: a retrospective cohort study using propensity-score matching Running title: The association between RDW and postoperative 30-day mortality

Abstract

Abstract Background: In terms of predicting surgery mortality, it is controversial whether red blood cell width works independently. In non-cardiac surgery patients older than 18 years, we intend to examine the relationship between red blood cell width and postoperative 30-day mortality. Methods: In this retrospective cohort study, 90,785 Singapore General Hospital patients were matched by propensity score between January 1, 2012 and October 31, 2016. It was determined that red blood cell width at baseline and mortality within 30 days after surgery were the independent and dependent variables. We used a non-parametric multivariate logistic regression to balance the confounders among 7807 patients with high RDW and 7807 patients with non-high RDW in the propensity score matching. We investigated the association between RDW and 30-day mortality after surgery using the doubly robust estimation method. Results: Cohorts matched according to propensity score, the risk of 30-day mortality after surgery increased by 114.6.0% among high RDW group(OR = 2.146, 95%CI: 1.645–2.799, P＜0.00001). In crude model, there was a significant correlation between RDW and 30-day mortality after surgery (OR = 1.877, 95% CI: 1.476–2.388, P＜0.00001). In the propensity-score adjusted model, the risk of 30-day mortality after surgery dropped to 86.7% among people with high RDW (OR = 1.867, 95%CI: 1.467–2.376,P＜0.00001).Compared to non-high RDW group, the risk of 30-day mortality after surgery increased by 117.0% and 127.7% among high RDW group in the original cohort(OR: 2.170, 95%CI: 1.754–2.683, P＜0.00001) and the weighted cohort(OR: 2.272, 95%CI: 2.009–2.580, P＜0.00001),respectively. Conclusions: According to the results of this observational, propensity score-matched cohort study, there is a significant correlation between higher RDW and higher postoperative 30-day mortality, that is to say, patients over the age of 18 with high preoperative RDW who undergo non-cardiac surgery have a worse postoperative prognosis than those with normal RDW.