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Anemia Is an Independent Predictor of Complications Following Pancreatectomy
Mark Pedersen*, Sundara Reddy, James J. Mezhir
University of Iowa, Iowa City, IA
The impact of anemia on operative complications following pancreatectomy has not been explored, and the optimal hemoglobin/hematocrit level for these patients is unknown. The objective of this study was to determine the impact of perioperative anemia on complications following pancreatectomy.
The ACS-NSQIP database was queried for patients who underwent enucleation, distal pancreatectomy, and pancreaticoduodenectomy between January 1, 2006 and December 31, 2013.Hematocrit levels were reported in the database and hemoglobin (HG) values were calculated from these levels. Patients with a hemoglobin less than 11.5 were defined as anemic. Univariate logistic regression and linear regression analysis was used to assess correlation between perioperative variables and post-operative complications. Multivariable logistic and linear regression models were then built based on predictor variables that were significantly associated with post-operative complications. To determine an optimal cutoff value for HG, receiver operator characteristic (ROC) analysis was performed.
30,312 elective pancreatectomy patients were included for analysis. There was a mean age of 62 and 49% male. There were 7470 (24%) patients defined as anemic at the time of resection. The overall complication rate was 41.6%). Hemoglobin levels were an independent, significant predictor of multiple adverse surgical outcomes including all complications, increased length of stay, stroke, prolonged mechanical ventilation (>48hrs) and reintubation, septic shock, pneumonia, DVT/thrombophlebitis and wound infection. Among patients who underwent pancreaticoduodenectomy for cancer HG levels were significantly associated with increased risk for any complication, increased length of stay, prolonged mechanical ventilation and reintubation, septic shock and pneumonia. ROC characteristic analysis showed that HG levels have an area under the curve of 0.59 for the prediction of all complications. The HG value that showed the highest sensitivity and specificity for all complications was 12.05 (sn = 58%, sp = 56%). A HG value of 13 showed a sensitivity of 87% with a specificity of 19%.
These data provide evidence that anemic patients who undergo pancreaticoduodenectomy are at increased risk for post-operative complications. A HG level of 12 is optimal for minimizing complications. This information can be used to drive pre-operative assessment and care. Given the elective nature of these cases, there is the potential to address patients’ anemic status prior to resection.
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