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Impact of Preoperative Anemia on Outcomes of Enhanced Recovery Program After Colorectal Surgery: A Monocentric Retrospective Study

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Abstract

Background

Anemia is common before major abdominal surgery (35%). It is an independent factor for postoperative complications and longer length of stay (LOS). The aim of this study was to evaluate the extent to which preoperative anemia impacts on enhanced recovery programs (ERP) outcomes.

Materials and Methods

The data for patients scheduled for colorectal surgery between 2015 and 2019, were analyzed (n = 494). All patients were managed with the same ERP. Demographic data, preoperative risk factors, postoperative complications, LOS and adherence to ERP were compared between anemic and non-anemic patients. Anemia was defined by a hemoglobin concentration < 13 g dL−1 in men and < 12 g dL−1 in women.

Results and Discussion

In total, 173 patients had preoperative anemia. They were older (p < 0.001) and more often male (p = 0.02). The following risk factors were significantly more frequent in the anemic group: renal failure (p = 0.04), malnutrition (p < 0.001), cardiac arrhythmia (p < 0.001), coronaropathy (p = 0.02) and anticoagulant treatment (p < 0.001). Despite more risk factors, anemic patients did not experience more postoperative complications (38.2% vs. 31.2%, p = 0.12). Overall adherence to ERP was similar (18 [16–19] vs. 18 [17–19], p = 0.06). LOS was 4 [3–7] and 3 [2–6.25] days in the anemic and the non-anemic groups, respectively (p < 0.002). Multivariate analysis showed that anemia did not affect LOS (p = 0.27).

Conclusion

Our study suggests that preoperative anemia does not detract from the benefits of ERP after elective colorectal surgery.

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References

  1. Fowler AJ, Ahmad T, Phull MK et al (2015) Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg 102:1314–1324. https://doi.org/10.1002/bjs.9861

    Article  CAS  PubMed  Google Scholar 

  2. Muñoz M, Gómez-Ramírez S, Campos A et al (2015) Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfus 13:370–379. https://doi.org/10.2450/2015.0014-15

    Article  PubMed  PubMed Central  Google Scholar 

  3. Musallam KM, Tamim HM, Richards T et al (2011) Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 378:1396–1407. https://doi.org/10.1016/S0140-6736(11)61381-0

    Article  PubMed  Google Scholar 

  4. Baron DM, Hochrieser H, Posch M et al (2014) Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients. Br J Anaesth 113:416–423. https://doi.org/10.1093/bja/aeu098

    Article  CAS  PubMed  Google Scholar 

  5. Klein AA, Collier TJ, Brar MS et al (2016) The incidence and importance of anaemia in patients undergoing cardiac surgery in the UK: the first Association of Cardiothoracic Anaesthetists national audit. Anaesthesia 71:627–635. https://doi.org/10.1111/anae.13423

    Article  CAS  PubMed  Google Scholar 

  6. Ferraris VA, Davenport DL, Saha SP et al (2012) Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Arch Surg 147:49–55. https://doi.org/10.1001/archsurg.2011.790

    Article  PubMed  Google Scholar 

  7. Leichtle SW, Mouawad NJ, Lampman R et al (2011) Does preoperative anemia adversely affect colon and rectal surgery outcomes? J Am Coll Surg 212:187–194. https://doi.org/10.1016/j.jamcollsurg.2010.09.013

    Article  PubMed  Google Scholar 

  8. Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617. https://doi.org/10.1093/bja/78.5.606

    Article  CAS  PubMed  Google Scholar 

  9. Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298. https://doi.org/10.1001/jamasurg.2016.4952

    Article  PubMed  Google Scholar 

  10. Gustafsson UO, Scott MJ, Hubner M et al (2019) Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations: 2018. World J Surg 43:659–695. https://doi.org/10.1007/s00268-018-4844-y

    Article  CAS  PubMed  Google Scholar 

  11. ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection. Ann Surg 261:1153–1159. https://doi.org/10.1097/SLA.0000000000001029

  12. Ripollés-Melchor J, Ramírez-Rodríguez JM, Casans-Francés R et al (2019) Association between use of enhanced recovery after surgery protocol and postoperative complications in colorectal surgery: the postoperative outcomes within enhanced recovery after surgery protocol (POWER) study. JAMA Surg 154:725–736. https://doi.org/10.1001/jamasurg.2019.0995

    Article  PubMed  PubMed Central  Google Scholar 

  13. WHO (2011) Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. In: Vitamin and mineral nutrition information system. World Health Organization, Geneva

  14. Fiore JF, Bialocerkowski A, Browning L et al (2012) Criteria to determine readiness for hospital discharge following colorectal surgery: an international consensus using the Delphi technique. Dis Colon Rectum 55:416–423. https://doi.org/10.1097/DCR.0b013e318244a8f2

    Article  PubMed  Google Scholar 

  15. Aarts M-A, Rotstein OD, Pearsall EA et al (2018) Postoperative ERAS interventions have the greatest impact on optimal recovery. Ann Surg 267:992–997. https://doi.org/10.1097/SLA.0000000000002632

    Article  PubMed  Google Scholar 

  16. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  17. Jammer I, Wickboldt N, Sander M et al (2015) Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine. Eur J Anaesthesiol 32:88–105. https://doi.org/10.1097/EJA.0000000000000118

    Article  PubMed  Google Scholar 

  18. Gustafsson UO, Scott MJ, Schwenk W et al (2013) Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg 37:259–284. https://doi.org/10.1007/s00268-012-1772-0

    Article  CAS  PubMed  Google Scholar 

  19. Alfonsi P, Slim K, Chauvin M et al (2014) French guidelines for enhanced recovery after elective colorectal surgery. J Visc Surg 151:65–79. https://doi.org/10.1016/j.jviscsurg.2013.10.006

    Article  CAS  PubMed  Google Scholar 

  20. Joris J, Hans G, Coimbra C et al (2020) Elderly patients over 70 years benefit from enhanced recovery programme after colorectal surgery as much as younger patients. J Visc Surg 157:23–31. https://doi.org/10.1016/j.jviscsurg.2019.07.011

    Article  CAS  PubMed  Google Scholar 

  21. Greco M, Capretti G, Beretta L et al (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38:1531–1541. https://doi.org/10.1007/s00268-013-2416-8

    Article  PubMed  Google Scholar 

  22. Slieker J, Frauche P, Jurt J et al (2017) Enhanced recovery ERAS for elderly: a safe and beneficial pathway in colorectal surgery. Int J Colorectal Dis 32:215–221. https://doi.org/10.1007/s00384-016-2691-6

    Article  CAS  PubMed  Google Scholar 

  23. Jurt J, Slieker J, Frauche P et al (2017) Enhanced recovery after surgery: can we rely on the key factors or do we need the bel ensemble? World J Surg 41:2464–2470. https://doi.org/10.1007/s00268-017-4054-z

    Article  PubMed  Google Scholar 

  24. Meunier A, Sorce G, Hardy P-Y et al (2021) Comparison of outcome after right colectomy with an enhanced recovery programme in patients with inflammatory bowel disease and patients operated on for other conditions: a monocentric retrospective study. Int J Colorectal Dis. https://doi.org/10.1007/s00384-020-03830-5

    Article  PubMed  Google Scholar 

  25. Jørgensen CC, Madsbad S, Kehlet H (2015) Postoperative morbidity and mortality in type-2 diabetics after fast-track primary total hip and knee arthroplasty. Anesth Analg 120:230–238. https://doi.org/10.1213/ANE.0000000000000451

    Article  PubMed  Google Scholar 

  26. Mueller MM, Van Remoortel H, Meybohm P et al (2019) Patient blood management. JAMA 321:983. https://doi.org/10.1001/jama.2019.0554

    Article  PubMed  Google Scholar 

  27. Munting KE, Klein AA (2019) Optimisation of pre-operative anaemia in patients before elective major surgery: why, who, when and how? Anaesthesia 74:49–57. https://doi.org/10.1111/anae.14466

    Article  CAS  PubMed  Google Scholar 

  28. Richards T, Baikady RR, Clevenger B et al (2020) Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial. Lancet 396:1353–1361. https://doi.org/10.1016/S0140-6736(20)31539-7

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Acknowledgements

This study approved by the Institutional Ethics Committee of Centre Hospitalier Universitaire de Liège (Liège, Belgium, Chair: Prof. V. Seutin, No. 2020-302). The guidelines of the STROBE Statement have been adopted. Accepted at the 2020 SFAR (Société Française d’Anesthésie Réanimation) annual meeting for abstract presentation, September 24, 2020 (canceled due to the COVID crisis).

Funding

This study received financial support from GRACE (Francophone Group for Enhanced Recovery after Surgery, Beaumont, France, www.grace-asso.fr). The funding source had no involvement in study design, in collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, CHU Liège, University of Liège, Domaine Universitaire du Sart Tilman, Avenue de L’Hôpital, 1 Bat B35, 4000, Liège, Belgium

    Pierre-Yves Hardy, Maxime Degesve, Jean Joris & Gregory Hans

  2. Groupe francophone de réhabilitation améliorée après chirurgie, GRACE, Beaumont, France

    Pierre-Yves Hardy, Jean Joris & Carla Coimbra

  3. Service of Abdominal Surgery, CHU Liège, University of Liège, Domaine Universitaire du Sart Tilman, Avenue de L’Hôpital, 1 Bat B35, 4000, Liège, Belgium

    Carla Coimbra & Emmanuel Decker

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  1. Pierre-Yves Hardy
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  2. Maxime Degesve
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Correspondence to Pierre-Yves Hardy.

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Appendix 1

Appendix 1

See Table 8.

Table 8 STROBE Statement—checklist
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Hardy, PY., Degesve, M., Joris, J. et al. Impact of Preoperative Anemia on Outcomes of Enhanced Recovery Program After Colorectal Surgery: A Monocentric Retrospective Study. World J Surg 45, 2326–2336 (2021). https://doi.org/10.1007/s00268-021-06161-w

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  • DOI: https://doi.org/10.1007/s00268-021-06161-w

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