|
Back to 2014 Annual Meeting Posters
Preoperative Anemia and Outcomes in Elective Colorectal Surgery
Gabriela Vargas*1, Abhishek Parmar1,2, Kristin Sheffield1, Nina Tamirisa1,2, Taylor S. Riall1
1General Surgery, University of Texas Medical Branch, Galveston, TX; 2General Surgery, University of California San Francisco-East Bay, Oakland, CA
INTRODUCTION: Preoperative anemia is common in patients with inflammatory bowel disease (IBD) and diverticulosis. The aim of this study was to evaluate the association between preoperative anemia and postoperative morbidity and mortality in this subset of patients undergoing elective colon or rectal surgery.
METHODS: We used data from the National Surgical Quality Improvement Project (NSQIP) from 2005-2011 to identify 30,982 elective colorectal resections in patients with a preoperative diagnosis of IBD or diverticulosis/diverticulitis. Joint point analysis was performed to determine the hematocrit level at which the rate of complications began increasing. Based on the identified inflection point, anemia was defined as a hematocrit less than or equal to 38%. Morbidity and mortality rates were calculated for patients with and without anemia. Morbidity was defined as the presence of any infectious, cardiovascular, pulmonary, renal, thromboembolic, and bleeding event within 30 days of surgery. Multivariable logistic regression models were used to evaluate the association between every 5% decrease in hematocrit and complications in patients with anemia (hematocrit > 38%) and without anemia (hematocrit ≤ 38%).
RESULTS: Preoperative anemia was identified in 37.4% of the cohort. The overall morbidity and 30-day operative mortality rates were 20.9% and 0.4%, respectively. Postoperative complications (24.3% vs. 18.9%, p<0.0001) and postoperative mortality (0.8% vs. 0.2%, p<0.0001) were more common in patients with anemia compared to patients without anemia. In the adjusted models, hematocrit was not significantly associated with complications for patients with a preoperative hematocrit >38%. However, in patients with hematocrit ≤ 38%, every 5% decrease in hematocrit was associated with a 14% increase in the odds of developing complications (OR 1.14; 95% CI 1.08-1.20 (Table)). This association was independent of receipt of transfusion, which was a significant predictor of complications in both groups.
CONCLUSIONS: Below a hematocrit of 38%, the risk of complications increases progressively as hematocrit decreases. Our data support delaying elective colorectal resection until measures are taken to correct preoperative anemia. Multivariable Logistic Regression Models-Factors Associated with Postoperative Complications | Factors (REF) | Patients with hematocrit > 38% OR (95% CI) N = 19,406 | Patients with hematocrit ≤ 38% OR (95% CI) N = 11,576 | | Preoperative hematocrit | 0.95 (0.93-1.06) | 1.14 (1.07-1.20) | | Transfusion (No) | 3.66 (2.80-4.78) | 2.11 (1.79-2.50) |
Models controlled for the following patient factors: age, sex, BMI, diabetes, tobacco use, COPD, ascites, CHF, HTN, dialysis, wound infection, chronic steroid use, >10% weight loss, bleeding disorder, and functional status prior to surgery. Transfusion defined as any transfusion of packed red blood cells or whole blood given from the time the patient leaves the operating room up to and including 72 hrs postoperatively.
Back to 2014 Annual Meeting Posters
|
