Is preoperative anemia a significant risk factor for splenectomy patients? A NSQIP analysis.
Journal
Surgery open science
ISSN: 2589-8450
Titre abrégé: Surg Open Sci
Pays: United States
ID NLM: 101768812
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
12
03
2020
revised:
19
04
2020
accepted:
28
04
2020
entrez:
6
8
2020
pubmed:
6
8
2020
medline:
6
8
2020
Statut:
epublish
Résumé
Prior literature has examined the association between preoperative anemia and complications across surgical settings; however, evidence is lacking for splenectomy patients. We investigated the association between preoperative hematocrit and 30-day postoperative outcomes in this population using a national database. Patients who underwent splenectomy (2012-2017) were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Analyses were performed for the overall cohort and elective versus emergent subsets, adjusting for transfusion among other covariates. Our sample included 5,580 patients. As hematocrit decreased, complication rates increased incrementally in both the univariate and multivariate analyses. Adjusted odds ratios (and 95% confidence intervals) for moderate anemia (26% ≤ hematocrit < 30%) as compared to no anemia (hematocrit ≥ 38%) were readmission = 1.5 (1.1-1.8), sepsis = 2.2 (1.6-3.0), and composite outcome = 1.8 (1.0-3.2). Parameter estimates (standard error, P value) for the moderate versus no anemia group were length of stay = 3.0 (0.5, P < .001) and days to discharge = 1.2 (0.3; P < .001). Our results demonstrate a dose-response relationship between increasing degree of anemia and odds of various postoperative adverse outcomes after adjusting for several potential confounders. The subset analysis further suggests that elective splenectomy cases are more likely to have poor outcomes when in the presence of anemia or when transfusions are performed as compared to emergent cases. This suggests that the harm associated with transfusion may offset the benefit of optimizing anemia in an elective splenectomy case.
Sections du résumé
BACKGROUND
BACKGROUND
Prior literature has examined the association between preoperative anemia and complications across surgical settings; however, evidence is lacking for splenectomy patients. We investigated the association between preoperative hematocrit and 30-day postoperative outcomes in this population using a national database.
METHODS
METHODS
Patients who underwent splenectomy (2012-2017) were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Analyses were performed for the overall cohort and elective versus emergent subsets, adjusting for transfusion among other covariates.
RESULTS
RESULTS
Our sample included 5,580 patients. As hematocrit decreased, complication rates increased incrementally in both the univariate and multivariate analyses. Adjusted odds ratios (and 95% confidence intervals) for moderate anemia (26% ≤ hematocrit < 30%) as compared to no anemia (hematocrit ≥ 38%) were readmission = 1.5 (1.1-1.8), sepsis = 2.2 (1.6-3.0), and composite outcome = 1.8 (1.0-3.2). Parameter estimates (standard error, P value) for the moderate versus no anemia group were length of stay = 3.0 (0.5, P < .001) and days to discharge = 1.2 (0.3; P < .001).
CONCLUSION
CONCLUSIONS
Our results demonstrate a dose-response relationship between increasing degree of anemia and odds of various postoperative adverse outcomes after adjusting for several potential confounders. The subset analysis further suggests that elective splenectomy cases are more likely to have poor outcomes when in the presence of anemia or when transfusions are performed as compared to emergent cases. This suggests that the harm associated with transfusion may offset the benefit of optimizing anemia in an elective splenectomy case.
Identifiants
pubmed: 32754713
doi: 10.1016/j.sopen.2020.04.002
pii: S2589-8450(20)30012-9
pmc: PMC7391880
doi:
Types de publication
Journal Article
Langues
eng
Pagination
101-106Informations de copyright
© 2020 The Authors.
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