Guillaume S Chevrollier, MD1, Andrew M Brown, MD1, Scott W Keith, PhD2, Joanne Scewczyk, BS1, Michael J Pucci, MD1, Karen A Chojnacki, MD1, Ernest L Rosato, MD1, Francesco Palazzo, MD1. 1Sidney Kimmel Medical College of Thomas Jefferson University, Department of Surgery, 2Thomas Jefferson University, Department of Biostatistics
INTRODUCTION: The increased incidence of anemia in patients with a hiatal hernia (HH) has been clearly demonstrated, as has resolution of anemia after HH repair in these patients. Despite this, the implications of preoperative anemia on postoperative outcomes have not been well described. In this study, we aimed to identify the incidence of preoperative anemia in patients undergoing HH repair at our institution and sought to determine whether preoperative anemia had an impact on postoperative outcomes.
METHODS AND PROCEDURES: Using our IRB-approved institutional HH database, we retrospectively identified patients undergoing HH repair between January 2011 and April 2017 at our institution. We identified all patients with anemia, defined as serum hemoglobin levels less than 13 mg/dL in men and 12 mg/dL in women, measured within two weeks prior to surgery, and compared this cohort to those that had normal hemoglobin values preoperatively. Specific perioperative outcomes analyzed included: estimated blood loss (EBL), operative time, need for blood transfusion, failure to extubate postoperatively, intensive care unit (ICU) admission, postoperative complications, length of stay (LOS), and 30-day readmission.
RESULTS: We identified 266 patients undergoing HH repair, of which 233 had preoperative bloodwork available for review. The average age was 64 years and the majority of patients were female (79%, n=208). Most were treated electively (75%, n=196) and with a minimally invasive approach (97%, n=255). 70 patients (26.6%) had preoperative anemia. Compared to patients without anemia, patients with anemia had increased rates of failed extubation postoperatively (7.1% vs. 1.5%, p=0.033), increased ICU admissions (12.9% vs. 5.1%, p=0.034), increased need for perioperative blood transfusions (11.4% vs 0%, p=0.0003), and increased rates of postoperative complications (41.4% vs. 18.1%, p<0.0001). Although mean LOS (4.3 days vs. 3.2 days, p=0.077), mean operating time (262 mins vs. 252 mins, p=0.10), and EBL (52 ml vs 38 ml, p=0.38) were greater in the anemic group, they did not reach statistical significance, and there was no significant difference in 30-day readmission rate (8.6% vs 8.8%, p=0.95).
CONCLUSIONS: Anemia diagnosed on preoperative bloodwork appears to be associated with increased failure to extubate postoperatively, need for ICU admissions, need for perioperative blood transfusion, and increased overall complication rate after HH repair. However, we found no significant difference in LOS or 30-day readmissions between anemic and non-anemic patients. Since the majority of patients in this analysis underwent elective repairs, these results would support the preoperative treatment of anemia in patients undergoing HH repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87007
Program Number: P428
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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