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Preoperative anemia: a common finding that predicts worse outcomes in patients undergoing primary hiatal hernia repair

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Abstract

Background

The increased incidence of anemia in patients with hiatal hernias (HH) and resolution of anemia after HH repair (HHR) have been clearly demonstrated. However, 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 primary HHR at our institution and sought to determine whether preoperative anemia had an impact on postoperative outcomes.

Methods

Using our IRB-approved institutional HH database, we retrospectively identified patients undergoing primary HHR between January 2011 and April 2017 at our institution. We identified 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 group to a cohort of patients with normal preoperative hemoglobin. Perioperative outcomes analyzed included estimated blood loss (EBL), operative time, perioperative blood transfusions, failed postoperative extubation, intensive care unit (ICU) admission, postoperative complications, length of stay (LOS), and 30-day readmission. Outcomes were compared by univariable and multivariable analyses, with significance set at p < 0.05.

Results

We identified 263 patients undergoing HHR. The median age was 66 years and most patients were female (78%, n = 206). Seventy patients (27%) were anemic. In unadjusted analyses, anemia was significantly associated with failed postoperative extubation (7 vs. 2%, p = 0.03), ICU admission (13 vs. 5%, p = 0.03), postoperative blood transfusions (9 vs. 0%, p < 0.01), and postoperative complications (41 vs. 18%, p < 0.01). On adjusted multivariable analysis, anemia was associated with 2.6-fold greater odds of postoperative complications (OR 2.57; 95% CI 1.36–4.86; p < 0.01).

Conclusions

In this study, anemia had a prevalence of 27% in patients undergoing primary HHR. Anemic patients had 2.6-fold greater odds of developing postoperative complications. Anemia is common in patients undergoing primary HHR and warrants consideration for treatment prior to elective repair.

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Authors and Affiliations

  1. Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, 1100 Walnut St. 5th Floor, Philadelphia, PA, 19107, USA

    Guillaume S. Chevrollier, Andrew M. Brown, Joanne Szewczyk, Michael J. Pucci, Karen A. Chojnacki, Ernest L. Rosato & Francesco Palazzo

  2. Department of Biostatistics, Thomas Jefferson University, Philadelphia, PA, USA

    Scott W. Keith

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  1. Guillaume S. Chevrollier
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Correspondence to Francesco Palazzo.

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Disclosures

Drs. Chevrollier, Brown, Keith, Pucci, Chojnacki, Rosato, and Palazzo, as well as Ms. Szewczyk, have no conflicts of interest or financial ties to disclose.

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Chevrollier, G.S., Brown, A.M., Keith, S.W. et al. Preoperative anemia: a common finding that predicts worse outcomes in patients undergoing primary hiatal hernia repair. Surg Endosc 33, 535–542 (2019). https://doi.org/10.1007/s00464-018-6328-4

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