Preoperative anemia is associated with increased use of hospital resources in patients undergoing elective hepatectomy

Tee, May C.; Shubert, Christopher R.; Ubl, Daniel S.; Habermann, Elizabeth B.; Nagorney, David M.; Que, Florencia G.

doi:10.1016/j.surg.2015.06.004

Cited by 19 publications

(15 citation statements)

References 49 publications

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“…Similarly, Tee et al found that preoperative anemia was associated with increased blood transfusion and prolonged time of stay in patients undergoing elective hepatectomy. 37 Preoperative anemia and intraoperative blood loss may lead to hyoxemia in tissue and organs, which further impedes tissue repair and reconstruction. 38 Paradoxically, blood transfusion may correct anemia and rescue the life of a patient with massive blood loss, yet it increases postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery

Lu¹,

Lu²,

Wu³

et al. 2018

CIA

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ObjectiveThe aim of this study was to determine the safety of elderly cancer patients (≥70 years) undergoing hepatic resection (HR) or pancreaticoduodenectomy (PD) in comparison with younger adults (<70 years).MethodsA total of 1,012 consecutive patients undergoing HR or PD were included. The incidence and severity of morbidity were documented within 30 days postoperatively and compared between elderly and younger groups. Risk factors associated with postoperative morbidity were investigated by multivariate logistic regression analysis.ResultsElderly patients (n=111, 11.0%) had more comorbidities and worse preoperative general condition and liver function versus younger patients (n=901, 89.0%), and thus were more likely to develop infectious (eg, systemic sepsis and urinary tract infection, both p<0.01) and technical-associated complications (intraperitoneal bleeding and biliary/pancreatic fistula, p=0.029 and p=0.074, respectively). However, the incidence and severity of complications were comparable between elderly and younger patients in the whole cohort, and also in HR and PD surgery groups separately. Preoperative hemoglobin (odds ratio [OR] 1.4, p=0.007) and intraoperative blood transfusion (OR 1.9, p=0.002), rather than age, were independently associated with postoperative morbidity. Hepatitis (OR 2.9, p=0.001), preoperative hemoglobin (OR 1.6, p=0.036), and pancreatic versus hepatic surgery (OR 2.3, p=0.005) were independently associated with postoperative infectious. For elderly patients only, American Society of Anesthesiologists (ASA) score III (OR 2.1, p=0.033) and intraoperative blood transfusion (OR 3.2, p=0.030) were independently associated with postoperative morbidity.ConclusionHR and PD can be safely performed in selected elderly patients versus younger patients. Elderly patients with ASA score III or above should be cautiously selected for major surgeries.

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Section: Discussionmentioning

confidence: 99%

Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery

Lu¹,

Lu²,

Wu³

et al. 2018

CIA

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“…Anaemia was defined as a haemoglobin of concentration of 12·5 g/l or less, corresponding with current definitions of mild anaemia. Although many patients experienced mild anaemia before surgery (28·2 per cent), this cut‐off was identified by two groups and was statistically optimal in the present cohort.…”

Section: Discussionmentioning

confidence: 99%

Three-point transfusion risk score in hepatectomy

Lemke

Law

et al. 2017

British Journal of Surgery

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“…Preoperative anemia has been associated with worse postoperative outcomes [35, 36] and multidisciplinary perioperative patient blood management strategies including preoperative hemoglobin optimization have been proposed [37]. Although other groups have developed simplified scoring models for predicting postoperative morbidity in hepatectomy [38], utilizing the online NSQIP calculator to carefully consider preoperative risk in conjunction with minimizing perioperative transfusion may result in decreased morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Blood transfusion is an independent predictor of morbidity and mortality after hepatectomy

Martin

Kerwin

Turrentine

et al. 2016

Journal of Surgical Research

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Background Previous studies have indicated that blood transfusion is associated with increased risk of worse outcomes among patients selected for hepatectomy. However, the independent effect of transfusion has not been confirmed. We hypothesize that blood transfusion is an independent factor that affects outcomes in patients undergoing hepatectomy. Materials and Methods Patients at tertiary care center who underwent hepatectomy between 2006 and 2013 were identified and linked with the ACS-NSQIP PUF dataset. Multivariable logistic regression analysis was used to estimate the effect of blood transfusion on 30-day mortality and morbidity, adjusted for differences in extent of resection and estimated probabilities of morbidity and mortality. Results Among 522 patients in the study, 48 (9.2%) patients required perioperative blood transfusion within 72 hours of resection, and 172 (33%) underwent major hepatectomy. Indications for hepatectomy included metastatic neoplasm (n=229, 44%), primary hepatic neoplasm (n=108, 21%), primary extra-hepatic biliary neoplasm (n=23, 4%), and non-malignant indications (n=162, 31%). Eighty-eight (17%) patients had a postoperative morbidity. Blood transfusion was significantly associated with postoperative morbidity (OR 4.18, 95% CI 2.18–8.02, p=0.0001) and mortality (OR 14.5, 95% CI 3.08–67.8, p=001), after adjustment for the concurrent effect of NSQIP estimated probability of morbidity (OR 1.15, 95% CI 0.11–12.2, p=0.042). The extent of resection was not significantly associated with morbidity (OR 1.30, 95% CI 0.74–2.28, p=0.366) or mortality (OR 1.14, 95% CI 0.24–5.50, p=0.870). Conclusions Blood transfusion is a highly statistically significant independent predictor of morbidity and mortality after hepatectomy. Judicious use of perioperative transfusion is indicated in patients with benign and malignant indications for liver resection.

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Preoperative anemia is associated with increased use of hospital resources in patients undergoing elective hepatectomy

Cited by 19 publications

References 49 publications

Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery

Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery

Three-point transfusion risk score in hepatectomy

Blood transfusion is an independent predictor of morbidity and mortality after hepatectomy

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