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Background: Preoperative anemia is a risk factor for blood transfusions and delayed postoperative recovery, but few data are available for pancreatic surgery. Aim of the study was to analyze the impact of preoperative anemia on outcomes after pancreatic resection.Methods: Retrospective review of 1107 patients resected at San Raffaele Hospital (2015-2018). Preoperative anemia was defined as hemoglobin lower than 130 g/L for men and 120 g/L for women. Primary outcome was 90-day comprehensive complication index (CCI). Analysis was stratified according to type of surgery; proximal resections (pancreaticoduodenectomy and total pancreatectomy) versus distal pancreatectomy.Results: In 776 proximal resection patients, preoperative anemia was associated with increased CCI (24 +/- 25 vs. 19 +/- 23, p = 0.018) and perioperative allogenic blood transfusions (n = 124, 46% vs. n = 129, 26%; p < 0.001). Multivariate analysis showed that anemia was associated with a 7% (95%CI 0.02-0.57 p = 0.047) increase in CCI, and was an independent factor associated with perioperative blood transfusion (OR 2.762, 95%CI 1.72-4.49, p < 0.001). In 331 distal pancreatectomies, anemia was not associated to increased morbidity but only to an increased risk of perioperative blood transfusion.Conclusion: Preoperative anemia is an independent risk factor for increased complication severity and blood transfusion in patients undergoing major pancreatic resection.

With the advent of practice changes surrounding preoperative patient optimization and postoperative protocols, a marked reduction has been reported in blood transfusion rates following total hip arthroplasty (THA). Thus, the purpose of this study was to examine differences in the prevalence of preoperative anemia, thrombocytopenia, elevated international normalized ratio (INR), bleeding disorders, and pre- and postoperative blood transfusions over the last decade. From 2011 to 2018, the American College of Surgeons National Quality Improvement Program database was queried for all primary THA procedures (n = 208,796). The following continuous variables were examined using analysis of variance: preoperative hematocrit (HCT), platelet count, and INR. The following categorical variables were analyzed by chi-squared tests: anemia (HCT 2.0, bleeding disorders, preoperative transfusions, and postoperative transfusions. There were decreases in preoperative anemia (2011: 16.2%; 2018: 11.4%, p 2.0 (2011: high = 1.1%; 2018: low = 0.7%, p = 0.001), bleeding disorders (2011: high = 2.9%; 2018: low = 2.0%, p

Introduction Anemia is a common and potentially modifiable condition in sub-Saharan Africa. We sought to determine the role of preoperative anemia on post laparotomy abdominal complications. Methods We conducted a six-month prospective, observational study of patients age >12 years following laparotomy at a tertiary hospital in Malawi. The outcome was the occurrence of abdominal complications. Poisson regression analyses estimated the risk of abdominal complications in patients with moderate/severe anemia. Results Of 280 patients, most were male (76.4%) with median age of 35 years (IQR 24–50). Abdominal complications developed in 34 patients (15.2%). Of the 224 patients with known preoperative hemoglobin 54 (20.7%) were moderately or severely anemic at the time of surgery. Patients with moderate-to-severe anemia had an increased risk of abdominal complications (RR 4.44, 95% CI 2.0–9.6). Conclusion Anemia is a common but modifiable comorbidity among laparotomy patients and independently increases the risk of abdominal complications.

Introduction: This systematic review aims to summarize the existing evidence relating to preoperative anemia and clinical outcomes in peripheral vascular surgery patients. Methods: The following databases were searched—PubMed, COCHRANE, LILACS, and Science Research—from 1 January 2010 up to 8 May 2020, with the last search performed on 1 January 2021. An additional manual search for potential primary studies was conducted on major journals (e.g., Anesthesiology, the British Journal of Anesthesia and the European Journal of Anaesthesiology) and reference lists of included studies. Google Scholar was also checked for additional eligible studies. Reviewers independently screened potentially eligible articles and extracted data from included studies on populations, interventions, comparisons, and outcomes. This review was registered at PROSPERO as CRD 180954. Results: In total, 6 observational studies with a combined total of 87,327 participants were analyzed. Data collected in this review suggest that preoperative anemia, especially when hemoglobin is p < 0.0001), limb amputation (OR: 5.2; 95% CI 3.1–8.6, p < 0.0001), and death (p < 0.0031). Conclusions: These data suggest an association between preoperative anemia, blood transfusion requirements, and other adverse clinical outcomes among patients subjected to peripheral vascular interventions. However, further investigations, particularly randomized controlled trials, are warranted to better understand the association between preoperative anemia and patients’ prognosis.

Background Transvenous lead extractions (TLEs) have increased in number due to an increased prevalence of cardiac implantable devices. Bleeding complications associated with TLEs can be catastrophic, and many institutions order blood components to be available in the procedure room. There are few studies supporting or refuting this practice. We evaluated transfusion rates for TLEs at a single, high-volume center to assess the need for having blood in the procedure room. Study design and methods Patients undergoing TLEs from April 2010 to February 2019 were identified from our institutional database. The percentage of patients transfused intraoperatively, the number of units transfused, and the reasons for transfusion were determined from the database and by manual chart review. Results A total of 473 patients underwent a TLE during this time frame. Of these, only 17 patients (3.6%) received a red blood cell (RBC) transfusion. Ten of the 17 patients received RBCs secondary to preoperative anemia. Of the remaining seven patients, only four patients received more than 2 RBC units, and only one received more than 10 RBC units. No patient received more than 2 RBC units or any plasma or platelets in the past 4 years. Conclusion Due to improvements in procedural techniques, advent of accessible remote blood allocation systems, and changes in transfusion practice (e.g., electronic crossmatch), routinely having blood components in the procedure room for every TLE may be an outdated practice for high-volume centers.

This study aimed to evaluate the prevalence of preoperative anemia and impacts of anemia and transfusion on survival in patients undergoing surgery for colorectal cancer. This study included patients who underwent surgery for primary colorectal cancer between 2011 and 2012. The influence of preoperative anemia and postoperative transfusion on recurrence-free survival and overall survival were retrospectively investigated. Anemia was defined as hemoglobin level

Background Nearly half of colorectal cancer (CRC) patients are diagnosed with anemia at the initial assessment (Ferlay et al., 2015). Anemic patients require blood transfusion, which increases cancer recurrence (Acheson et al., 2012). Hence iron therapy for anemia correction reduces postoperative morbidity and mortality. Aims To review randomized controlled trials on iron therapy for preoperative anemia in CRC patients. Methodology Includes formulating a review question, analyzing, quantifying the inclusion and exclusion criteria, literature search, quality assessment, data extraction and data synthesis, bias rectification, results interpretation and summarizing the evidence. Cochrane Handbook of Systematic Reviews and acronym PICO has been used for formulating review questions and study design (O’Connor et al., 2011). Selection Criteria Systematic reviews and RCTs with higher level of evidence were included in this review Data Extraction Quality assessment and data collection were done using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analysis) checklist. Data extraction and analysis done by REVMAN Manager (Higgins et al., 2011). Results Two trials reported that iron therapy reduces the need for blood transfusion, but with insignificant result. All three studies showed that hemoglobin rise occurs with iron therapy postoperatively. None of the studies analyzed the quality of life. Recommendations RCTs with larger sample size to be done for more relevant and accurate reports, aiming at the primary and secondary outcomes like morbidity, mortality and quality of life. Oral iron with fewer side effects has to be experimented for best efficacy.

The incidence of anemia and its association with postoperative complications in pediatric patients undergoing elective minor surgery are unknown. This study aims to determine the prevalence of anemia and its impact on postoperative complications in children undergoing elective minor surgery under general anesthesia. The preoperative complete blood count data of ASA I-II patients aged 1-18 years, for whom the pediatric surgery department planned an elective minor surgery under general anesthesia between January 1, 2019 and December 31, 2019, were evaluated retrospectively. The frequency of patients with abnormal hemoglobin values, the influence on preoperative treatment, the perioperative blood requirement and the complications were evaluated. Based on the specified inclusion interval, 851 of 3142 patients (784 Turks, 67 immigrants) met the inclusion criteria. It was observed that 24.38% of these patients had varying degrees of anemia (1.72% was rated as severe anemia). In addition, it was found that the operations of patients with anemia were not postponed and no additional assessment was required from the patients. It was found that the prevalence of anemia between Turkish patients and immigrant patients is similar. No complications were observed in the patients during the perioperative period. We found that the preoperative complete blood count test has limited value in patient management in children undergoing elective minor surgery and the prevalence of anemia in our area is quite high. Instead of routine laboratory tests, a careful medical history and physical examination are sufficient to determine the preoperative suitability of the pediatric patient before elective minor surgery.

Objective To identify the incidence and risk factors for 30-day postoperative mortality after microsurgical head and neck reconstruction following oncological resection. Study Design Retrospective case-control study. Setting American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Methods Microsurgical head and neck reconstructive cases were identified from 2005 to 2018 using Current Procedural Terminology codes and oncologic procedures using the International Classification of Disease 9 and 10 codes. The outcome of interest was 30-day mortality. Results The 30-day postoperative mortality rate was 1.2%. Univariate logistic regression analysis identified the following associations: age >80 years, hypertension, poor functional status, preoperative wound infection, renal insufficiency, malnutrition, anemia, and prolonged operating time. Multivariable logistic regression models were used to stratify further by the degree of malnutrition and anemia. Hematocrit

Although preoperative anemia has been suggested to predict postsurgical morbidity and mortality among infants1 year of age, the data were drawn from heterogeneous patient cohorts including severely ill infants undergoing complex, high-risk procedures. We aimed to determine whether untreated preoperative anemia was associated with increased risk of postoperative complications in infants1 year of age who underwent pyloromyotomy, a common and relatively simple surgery.Infants1 year of age undergoing pyloromyotomy were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric database. Preoperative anemia was defined as a hematocrit ≤40% for infants 0-30 days of age and ≤30% for infants more than 30 days of age. Patients who received pre- or postoperative blood transfusions were excluded.We identified 2948 patients who met our inclusion criteria, of whom 843 were anemic (29%). The overall rate of complications in this cohort was 6%. The most common postoperative complications were readmission (97 cases), surgical site infection (43), reoperation (39), prolonged hospital stay (24), urinary tract infection (3), 30-day mortality (3) and cardiac arrest (2). We found no differences in the incidence of complications in anemic versus nonanemic patients on bivariate analysis or multivariable logistic regression (adjusted odds ratio = 1.2; 95% confidence interval: 0.8-1.7; P = 0.319).In relatively healthy infants undergoing pyloromyotomy, untreated preoperative anemia was not associated with postoperative compilations and should not be considered a significant risk factor. Level of evidence III.

Jeder dritte chirurgische Patient hat bereits vor der Operation eine Anamie. Die Ursache ist meist ein Eisenmangel. Der Artikel soll das perioperative Risiko eines Eisenmangels mit/ohne Anamie beschreiben und potenzielle Praventionsmasnahmen aufzeigen. Darstellung verschiedener aktueller Originalarbeiten, Leitlinien sowie eigener Erfahrungen aus dem Deutschen Patient Blood Management Netzwerk. Ein praoperativer Eisenmangel mit/ohne Anamie ist ein unterschatzter Risikofaktor fur das Auftreten perioperativer Komplikationen. Die Einfuhrung einer praoperativen Diagnostik und Therapie im Rahmen eines umfassenden Patient Blood Management kann zur Komplikationspravention sowie Steigerung der Patientensicherheit beitragen.

Introduction: The cornerstone in the treatment of colorectal cancer is surgery. A surgical event poses a significant risk of decreased functional decline and impaired health-related quality of life. Prehabilitation is defined as the multimodal preoperative enhancement of a patient's condition. It may serve as a strategy to improve postoperative outcomes. Prehabilitation requires a multidisciplinary effort of medical health care professionals and a behavioral change of the patient.Methods: The goal of prehabilitation is threefold: (1) to reduce postoperative complications, (2) to enhance and accelerate the recovery of the patient, and (3) to improve overall quality of life. In this article, we introduce the FIT model illustrating a possible framework toward the implementation of both evidence-based and tailor-made prehabilitation for patients undergoing surgery for colorectal cancer.Results: The model is composed of three pillars: "facts" (how to screen patients and evidence on what content to prescribe), "integration" (data of own questionnaires assessing motivation of patients and specialists), and finally "tools" (which outcome measurements to use).Discussion: Developing implementable methods and defining standardized outcome instruments will help establish a solid base for patient-centered prehabilitation programs. Any party introducing prehabilitation requiring multidisciplinary teamwork and behavioral change can potentially use this framework.

Study Objective: This study aimed to determine the modifiable risk factors associated with surgical site infection (SSI) after cesarean section in adolescent pregnant patients. Design: Retrospective case-control study Setting: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey Participants: Pregnant adolescents (

Background: Preoperative anaemia is a common clinical situation that was proved to be associated with severe outcomes in major surgery but not pancreatic surgery alone. We aimed to study the impact of preoperative anaemia on morbidity and mortality in patients undergoing open pancreaticoduodenectomy by using propensity score matching (PSM) to balance the basal data and reduce bias. Methods: Consecutive patients undergoing open pancreaticoduodenectomy with complete record of preoperative haemoglobin at two pancreatic centers in China between 2015 to 2019 were analysed. Haemoglobin less than 12g/dl for male and 11g/dl for female were defined as anaemia in Chinese population. Clinical and economic outcomes were compared before and after propensity score matching (PSM). Logistic regression analysis was used to assess correlation between variables and anaemia. Results: The unmatched initial cohort consist of 517 patients. 148 cases (28.6%) were diagnosed as anaemia at admission, and no case received preoperative blood transfusion or anti-anaemia therapy. After PSM, 126 cases were in each group. The rate of severe postoperative complications was significantly higher in anaemia group than in normal group (43.7% versus 27.0%, P=0.006), among which prevalence of clinically relevant postoperative pancreatic fistula (31.0% versus 15.9%, P=0.005) and cardiac and cerebrovascular events (4.0% versus 0.0%, P=0.024) were most significant. It costed more in the anaemia group (26958.2±21671.9 versus 20987.7±10237.9 USD, P=0.013). Among all patients, multivariate analysis showed that preoperative obstructive jaundice [OR 1.813, 95%CI (1.206-2.725), P=0.004] and pancreatic ductal adenocarcinoma [OR 1.861, 95%CI (1.178-2.939), P=0.008] were predictors of anaemia. Among paired patients, preoperative anaemia [OR 2.593, 95%CI (1.481-5.541), P=0.001] and malignant pathology [OR 4.266, 95%CI (1.597-11.395), P=0.004] were predictors of postoperative severe complications.Conclusions: Preoperative anaemia is a predictor of cacoethic postoperative outcomes following open pancreatoduodenectomy and needs identified and treated.

Background: Red blood cell (RBC) transfusion increases morbidity and mortality after cardiac surgery. Despite the use of patient blood management methods, blood transfusions may still be needed in cardiac surgery. This study aims to determine the risk factors for blood transfusions in isolated coronary bypass graft surgery with the use of a restrictive transfusion strategy along with individualized patient blood management. Methods: A total of 198 consecutive patients (28 females, 170 males; age range 38–87) who underwent isolated CABG surgery in single private hospital using a restrictive transfusion strategy between April 2015 and October 2020 were included in the study. Patients were divided into two groups: with RBC transfusion and without RBC transfusion. Preoperative, intraoperative, and postoperative values were compared between groups. The risk factors for transfusion and transfusion probability were analyzed. Results: Preoperative hematocrit level and female gender (OR: 0.752; 95% CI 0.639–0.884; p = 0.001; OR: 7.874; 95% CI 1.678–36.950; p = 0.009, respectively) were the statistically significant independent risk factors for red blood cell transfusion. In female patients, the RBC transfusion probability was 61.08% when the preoperative hematocrit was 30%. The intensive care unit and hospital stay were longer in the blood transfusion group. Conclusions: The risk factors for RBC transfusion were preoperative anemia and female gender in isolated CABG surgery with restrictive blood transfusion strategies. Keywords: anemia, blood transfusion, coronary artery bypass, patient blood management, restrictive blood transfusion

Background Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. Methods This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. Results A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24 hours [16–30]. 4,222 (69.3%) patients moved in ≤ 24 hours after surgery. Local anesthesia [OR = 0.80 (95% confidence interval [CI]: 0.72–0.90); p = 0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55–0.60); p < 0.001], mean adherence to ERAS items [OR = 0.93 (95% CI: 0.92–0.93); p < 0.001], and preoperative hemoglobin [OR = 0.97 (95% CI: 0.96–0.98); p < 0.001] were associated with shorter time to mobilization. Conclusions Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.

Background: This study investigated the relationship between varying levels of preoperative anemia and postoperative complications within 30 days of total shoulder arthroplasty (TSA). Methods: All patients who underwent TSA from 2015 to 2017 were queried from the American College of Surgeons National Surgical Quality Improvement database. Patients were categorized based on preoperative hematocrit levels: normal (>39% for men and >36% for women), mild anemia (29% to 39% for men and 29% to 36% for women), and severe anemia (

Preoperative anemia is both a predictor of the need for a blood transfusion, as well as an independent risk factor for perioperative morbidity and mortality (Mantilla et al. Transfusion 51:82–91, 2011; Wu et al. JAMA 297:2481–2488, 2007; Carabini et al. J Neurosurg Anesthesiol 26:205–215, 2014; Rosencher et al. Transfusion. 43:459–469, 2003). A blood transfusion performed perioperatively is also an independent risk factor for severe morbid events and mortality (Beattie et al. Anesthesiology 110:574–581, 2009; Hebert et al. N Engl J Med 340:409–417, 1999). When used in conjunction with minimizing surgical blood loss and perioperative management strategies to improve patient tolerance for anemia, preoperative correction of anemia can help to avoid blood transfusion, improve length of stay, and reduce overall health costs. Much like all oncological processes are not identical, so too are the various kinds of anemia different, each with its own unique characteristics and optimal course of treatment.

Background Surgery for retroperitoneal soft tissue sarcoma (RPS) is technically challenging, often requiring perioperative red blood cell transfusion (PBT). In other cancers, controversy exists regarding the association of PBT and oncologic outcomes. No study has assessed this association in primary RPS, or identified factors associated with PBT. Methods Data was collected on all resected primary RPS between 2006 and 2020 at The Ottawa Hospital (Canada) and University Hospital Birmingham (United Kingdom). ‘PBT’ denotes transfusion given one week before surgery until discharge. Multivariable regression (MVA) identified clinicopathologic factors associated with PBT and assessed PBT association with oncologic outcomes. Surgical complexity was measured using resected organ score (ROS) and patterns of resection. Results 192 patients were included with 98 (50.8%) receiving PBT. Median follow-up was 38.2 months. High tumour grade (OR 2.20, P = 0.048), preoperative anemia (OR 2.78, P = 0.020), blood loss >1000 mL (OR 4.89, P = 0.004) and ROS >2 (OR 2.29, P = 0.026) were associated with PBT on MVA. A direct linear relationship was observed between higher ROS and increasing units of PBT (β = 0.586, P = 0.038). Increasingly complex patterns of resection were associated with increasing odds of PBT. PBT was associated with severe post-operative complications (P = 0.008) on MVA. Univariable association between PBT and 5-year disease-free or overall survival was lost upon MVA. Conclusions Surgical complexity and high tumour grade are potentially related to PBT. Oncologic outcomes are not predicted by PBT but are better explained by tumour grade which subsequently may increase surgical complexity. Strategies to reduce PBT should be considered in primary RPS patients.

Rationale: Lower extremity joint arthroplasty can lead to significant blood loss, and the need for blood transfusion. The use of blood products is associated with a variety of adverse outcomes including infection, circulatory overload, and transfusion reaction. Objectives: The objective of this quality improvement study is to identify the prevalence of preoperative anemia at our institution, and elucidate its impact on perioperative transfusion in elective patients undergoing primary or revision hip arthroplasty. Methods: Data for this study was collected from four databases at our institution. Elective patients undergoing primary or revision hip arthroplasty were selected. Transfusion was defined as the receipt of a red blood cell transfusion on the surgical day through to postoperative day five. The primary outcome was the effect of preoperative anemia on transfusion rates. Results: The overall transfusion rate was 7.6%. Transfusion rates for primary and revision arthroplasty were 5.8% and 18.7% respectively. Patients with a preoperative hemoglobin between 100 and 120 g/L were 4.5 times more likely to be transfused than those with a hemoglobin between 121 and 140 g/L, and 15.4 times more likely than those greater than 140 g/L. Preoperative anemia was common, with 11.5% of all patients having a preoperative hemoglobin of 120 g/L or less. Conclusion: Preoperative anemia was common and was significantly associated with higher transfusion rates. These findings reinforce the need to optimize hip arthroplasty patients prior to surgery, where possible. As a quality control study, these findings may help direct policy regarding the deferral of elective hip arthroplasty patients who are anemic preoperatively.

Background Surgical patients with preoperative anemia are more likely to experience adverse outcomes. Patient blood management (PBM) guidelines recommend screening and treating patients for anemia preoperatively to enable optimisation before surgery. This study investigates compliance with PBM guidelines and reports the association between length of stay and transfusion risk in patients with preoperative anemia. Study Design and Methods A retrospective, observational, chart audit that included all patients having primary, total hip and knee replacement surgery between July–December 2018 at a tertiary, metropolitan healthcare facility. Results Six hundred and seven patients patients were included, 96% (n = 583) patients had blood tests available (full blood count), and 8.1% (n = 49) had iron studies. Most patients 53% (n = 324) were screened between 2 and 6 days before surgery; 14.6% (n = 85) were anaemic preoperatively and only 5.9% (n = 5) of anaemic patients received treatment. Patients who had anemia preoperatively were more likely to receive a blood transfusion (odds ratio 8.65 [95% CI 3.98–18.76]) and stayed longer in hospital (median difference = 1, χ2 LR = 17.2, df=1, p

BackgroundThis study was designed to explore the prevalence and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture.MethodsFrom January 1, 2012, to December 31, 2018, 273 elderly patients over 70 years old with elective hip surgery were collected from the electronic medical records. Collected data included demographic characteristics, comorbidities, ASA classification, types of previous operations, types of anesthesia, operation time, fracture to operation time, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, whether transfusion, preoperative hospitalization, postoperative hospitalization, electrocardiograph, lower limb venous ultrasonography and total hospitalization time.ResultsIn these 273 patients, 15(5.6%) had ultrasonography evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement preoperatively. Fracture to surgery time, preoperative hemoglobin level, anemia, preoperative hospitalization, pulmonary disease and total hospitalization time were statistically different between DVT group and non-DVT group (P P = 0.027) and total hospitalization time (OR: 1.135; 95%CI: 1.023–1.259,P = 0.017) were the two independent risk factors for preoperative DVT.ConclusionPreoperative anemia and total hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.

Heinrich and Loop (1) recently commented our study on the ultra-short term combination treatment of anemia and iron deficiency in patients undergoing cardiac surgery (2). They discussed whether such treatment might be an option in lung cancer surgery and came to the conclusion that the optimal approach in lung cancer surgery would be to treat preoperative anemia (without specifying by which means) and to administer intravenous iron in patients with a higher risk of severe postoperative anemia such as following neo-adjuvant chemotherapy or pneumonectomy.

Preoperative anemia and allogeneic blood transfusions (ABTs) may affect outcomes in cancer surgery. The prevalence of anemia, the use of ABTs, the risks of transfusions, lengths of stay and mortality of oncological patients undergoing radical cystectomy were investigated in three University Hospitals in Germany.Hospital records of 220 consecutive patients undergoing radical cystectomy from 2010 to 2012 were retrospectively analyzed for independent risk factors of ABT and unfavorable outcomes (readmission, increased length of stay (LOS) or death) using multivariate regression analysis.Preoperative anemia was present in 40%. 70% of patients received blood transfusions. Low preoperative and intraoperative nadir hemoglobin levels were associated with receipt of ABT (OR 1.33, P = 0.04 and OR 2.94, P 0.001 respectively). Transfusion of ten or more red blood cell units (RBCs) during the entire hospital stay was a predictor of an increased LOS (P 0.001) and death (OR 52, 95%CI [5.9, 461.3], P 0.001), compared to non-transfused patients. Preoperative ABT and ASA scores were associated with ≥10RBCs.Anemic patients undergoing radical cystectomy had a high risk to receive ABTs. Preoperative transfusions and transfusion of ≥10RBCs during the entire hospital stay may increase patient`s mortality. Prospective, randomized controlled studies have to follow this study.

Background Anemia is the most common extraintestinal manifestation in patients with inflammatory bowel disease (IBD), and has been linked to severity of the disease. The aim of the study was to assess the impact of anemia on postoperative outcomes in patients with IBD. Methods We retrospectively reviewed patients with IBD from the NSQIP database over an 8-year period. Patients were grouped based on the presence of anemia. The impact of anemia on postoperative morbidity, mortality and length of stay was assessed. Results A total of 15,761 patients met our criteria. Half of the patients were anemic upon presentation. Anemic patients were more likely to have a history of steroid use, present with sepsis and require an emergency operation. In multivariate analysis, anemia was a significant predictor of overall morbidity, serious morbidity and increased length of stay. Conclusions Anemic patients with IBD present more often with sepsis and require emergency surgery compared to their peers. In addition, anemia serves as an independent predictor of overall complications, serious morbidity and increased length of stay following abdominal operations.

Objective : to identify the most important factors influencing the development of complications after radical cystectomy (RCE). Materials and methods . The results of 182 RCEs performed in September 2014 and December 2016 were analyzed. The patients included 152 (83.5 %) men and 30 (16.5 %) women. The patients’ age ranged from 31 to 84 years (mean age 62.3 years). An orthotopic urinary reservoir was formed in 138 (75.8 %) patients. Postoperative complications were evaluated according to the Clavien–Dindo classification. The calculations were made with a computer program for SPSS Statistics 16. Results. No complications were recorded in 84 (46.2 %) patients within 30 days after RCE. The development of various postoperative adverse reactions was observed in 98 (53.8 %) patients. The most common complications were gastrointestinal (26.9 %) and infectious (25.8 %). Sixteen (8.8 %) patients developed grade I complications; grades II, III, IV, and V complications were seen in 53 (29.1 %), 21 (11.5 %), 5 (2.7 %), in 3 patients, respectively. Thirty-day mortality was 1.64 %. Univariate regression analysis has established that overweight (p = 0.031), T status (p = 0.021), preoperative hemoglobin levels (p = 0.001), intraoperative blood loss (p = 0.009), and intraoperative abdominal cavity infection (p

Study Design: Retrospective analysis of prospectively collected data. Objectives: Few studies have investigated the role of preoperative anemia on postoperative outcomes of posterior cervical fusion. This study looked to investigate the potential relationship between preoperative anemia and postoperative outcomes following posterior cervical spine fusion. Methods: Data from patients undergoing elective posterior cervical fusions between 2005 and 2012 was collected from the American College of Surgeons National Surgical Quality Improvement Program database using inclusion/exclusion criteria. Multivariate analyses were used to identify the predictive power of anemia for postoperative outcomes. Results: A total of 473 adult patients undergoing elective posterior cervical fusions were identified with 106 (22.4%) diagnosed with anemia preoperatively. Anemic patients had higher rates of diabetes ( P = .0001), American Society of Anesthesiologists scores ≥3 ( P < .0001), and higher dependent functional status prior to surgery ( P < .0001). Intraoperatively, anemic patients also had higher rates of neuromuscular injuries ( P = .0303), stroke ( P = .013), bleeding disorders ( P = .0056), lower albumin ( P < .0001), lower hematocrit ( P < .0001), and higher international normalized ratio ( P = .002). Postoperatively, anemic patients had higher rates of complications ( P < .0001), death ( P = .008), blood transfusion ( P = .001), reoperation ( P = .012), unplanned readmission ( P = .022), and extended length of stay (>5 days; P < .0001). Conclusions: Preoperative anemia is linked to a number of postoperative complications, which can increase length of hospital stay and increase the likelihood of reoperation. Identifying preoperative anemia may play a role in optimizing and minimizing the complication rates and severity of comorbidities following posterior cervical fusion.

Study Design: Retrospective cohort study. Objective: Preoperative anemia has been associated with an increased need for blood transfusions and postoperative complications. The effects of anemia on the outcomes of anterior cervical discectomy and fusion (ACDF) have not been explored. The present study aimed to evaluate the association between preoperative anemia and 30-day complications following ACDF surgery. Methods: Data from the American College of Surgeons National Surgical Quality Improvement Program (2005-2012) was used. Preoperative anemia was defined as hematocrit

To identify rates, risks, and complications of red blood cell (RBC) transfusion in metastatic spinal tumor surgery.The multicenter prospective American College of Surgeons National Quality Improvement Program database was queried for the years 2012-2016. Adult patients with disseminated cancer who underwent metastatic spinal tumor surgery were identified. Transfusion was defined as having received at least 1 intraoperative/postoperative RBC transfusion within the first 72 hours of surgery start time. A stepwise multiple logistic regression model with backward elimination was used.Of 1601 patients identified, 623 patients (38.9%) received a RBC transfusion. Independent predictors of RBC transfusion included higher American Society of Anesthesiologists class (odds ratio [OR] = 1.54), preoperative anemia (OR = 3.10), instrumentation (OR = 1.63), and longer operative time (OR = 1.52). The overall complication rate was significantly higher in patients who received a transfusion compared with patients who did not receive a transfusion (22.3% vs. 15.0%, P0.001). Individual complications that were more common in patients who received a transfusion were sepsis (3.5% vs. 1.9%, P = 0.050), deep vein thrombosis (6.1% vs. 3.3%, P = 0.007), and prolonged ventilation (3.9% vs. 1.3%, P = 0.001). RBC transfusion (OR = 1.65), hypoalbuminemia (OR = 1.53), and anterior/anterolateral approaches for corpectomy (OR = 2.11) were independent risk factors for developing a postoperative complication.RBC transfusion after metastatic spinal tumor surgery may increase the risk of early postoperative complications. Future research into preoperative patient optimization and decreasing intraoperative blood loss is needed.

INTRODUCTION: Anemia is common in patients undergoing thoracic surgery due to three main risk factors including iron deficiency, chronic disease and iatrogenic factors, all of which can be prevented and treated. Our hypothesis was that the incidence of anemia may be higher than expected and associated with perioperative complications. METHODS: The data belonging to a total of 107 adult patients were included in the final analysis. We recorded demographic features, pre- and postoperative laboratory findings, comorbidities, blood transfusion rates, complications, mortality, type of surgery, rate of re-exploration,and duration of hospital stay. RESULTS: The incidence of anemia was 43.9%, being higher in men with 57.4 percent. Anemic patients had a significantly prolonged hospital stay, higher rate of ICU hospitalizations, higher levels of pre- and postoperative creatinine and lower levels of postoperative Hb, Htc and preoperative INR (p

Current literature suggests that preoperative hematocrit levels may play an important role in determining risk for complications after total hip arthroplasty (THA). The purpose of this study was to determine the role of preoperative anemia status on 30-day complications after THA.Using the National Surgical Quality Improvement Program registry from 2006 to 2016, we identified all patients who underwent primary THA. Patients were placed into 3 cohorts based on preoperative hematocrit levels (normal36% [N = 166,538], mild anemia 27%-36% [N = 13,214], and severe anemia27% [N = 541]). Differences in 30-day postoperative medical complications and readmission rates were compared using bivariate and multivariate analyses.Multivariate logistic regression analysis identified mild anemia compared with normal hematocrit as a significant risk factor for total complications (OR: 1.46, P.001), mortality (OR: 2.06, P.001), renal complications (OR: 2.59, P.001), respiratory complications (OR: 1.89, P.001), sepsis (OR: 2.01, P .001), wound infection (OR: 1.36, P.001), and urinary tract infection (OR: 1.44, P.001). Severe anemia was also risk factor, with a higher odds ratio, for total complications (OR: 1.99, P.001). Both mild and severe anemia were significant risk factors for increased rates of perioperative blood transfusion (mild: OR, 4.04, severe: OR, 5.58), nonhome discharge (OR: 1.74, OR: 1.64), and unplanned hospital readmissions (OR: 1.42, OR: 1.66).Preoperative anemia is a significant risk for perioperative complications after primary THA. Even mild anemia can lead to significantly increased risks of mortality, medical complications, and unplanned hospital readmissions in THA. This study further supports the need for screening and preoperative intervention for patients in this at-risk group.

Anemia has been identified as a risk factor for postoperative morbidity and mortality after major vascular procedures. Carotid revascularization carries less cardiac morbidity and physiologic stress compared with other vascular interventions. This study evaluated the association between preoperative anemia and major adverse events after carotid revascularization.Patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS) between January 2012 and June 2018 in the Vascular Quality Initiative database were identified. Anemia was defined as a preoperative hemoglobin level of 12 g/dL in women and 13 g/dL in men. Multivariable logistic analysis and 1:1 coarsened exact matching were used to study the association between preoperative anemia and in-hospital major adverse cardiac events (MACEs), defined as a composite of stroke, death, and myocardial infarction, and between anemia and 30-day mortality after CEA and CAS.Of 102,719 patients included in the analysis, 34.8% were anemic (CEA, 34.1%; CAS, 37.8%; P .001). Anemic patients were older and had more medical comorbidities compared with nonanemic patients. In-hospital MACEs (2.8% vs 1.9%; P .001) and 30-day mortality (0.9% vs 0.4%; P .001) were higher among anemic patients. On multivariable analysis, anemia was associated with 18% higher odds of in-hospital MACEs (odds ratio, 1.18; 95% confidence interval, 1.07-1.31, P = .001) and 74% higher odds of 30-day mortality (odds ratio, 1.74; 95% confidence interval, 1.40-2.17, P .001). Coarsened exact matching showed similar results. The association between preoperative anemia and adverse outcomes was similar in both CAS and CEA and in symptomatic and asymptomatic patients (P interaction.05).Anemia is associated with increased odds of adverse events after CEA and CAS. It should be factored into the preoperative risk assessment of patients undergoing carotid revascularization. Prospective studies are needed to study the effectiveness of correcting low preoperative hemoglobin levels in these patients and the association between anemia and long-term outcomes after CEA and CAS.

Aim This study was designed to explore the prevalence condition and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods From January 1, 2012, to December 31, 2018, 273 elderly over 70 years old with elective hip surgery were collected from the electronic medical records. Collected Data included demographic characteristics, comorbidities, ASA classification, types of surgeries, types of anesthesia, operation time, fracture to operation time, perioperative blood transfusion, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, electrocardiograph, lower limb venous ultrasound and hospitalization time. Results In all patients, 15 patients (5.6%) had venographic evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement. Fracture to surgery time, preoperative hemoglobin level, anemia, pulmonary disease and hospitalization time were statistically different between DVT group and non-DVT group (P

BACKGROUND: There is still controversy about the relationship between preoperative anemia and outcomes after rectal cancer surgery. OBJECTIVE: The aim of this study was to analyze the association between preoperative anemia and postoperative complications and the survival of patients undergoing surgery for rectal cancer in the era of laparoscopic surgery and modern perioperative care. DESIGN: This was a cohort study. SETTINGS: Data were gathered from 71 hospitals in The Netherlands. PATIENTS: Patients who underwent resection for rectal cancer in 2011, for whom preoperative hemoglobin level was registered, were included. INTERVENTIONS(s): There were no interventions. MAIN OUTCOME MEASURES: Short-term outcome parameters were any postoperative complication or mortality within 30 days postoperatively, and pelvic infectious complications defined as anastomotic leakage and presacral abscess. Long-term outcomes were chronic sinus diagnosed at any time during 3-year follow-up, 3-year local and distant recurrence rates, and 3-year overall survival. RESULTS: Of 2095 patients, 1857 had a registered preoperative hemoglobin level; 576 (31%) of these patients anemic and 1281 (69%) were nonanemic. Preoperative anemia was not independently associated with postoperative complications (HR, 1.1; 95% CI, 0.9-1.4; p = 0 center dot 24) or 30-day mortality (HR, 1.4, 95% CI, 0.7-2.8; p = 0 center dot 29). Preoperative anemia was associated with 3-year overall survival (HR, 2.1; 95% CI, 1.7-2.5; p

Objectives To assess sex specific differences in 30 day mortality, length of hospital stay, and adverse neurological events following repair of intact degenerative descending thoracic aortic aneurysms (TAAs), by either thoracic endovascular (TEVAR) or open repair. Methods MEDLINE, Embase, and CENTRAL databases were searched from 2005 to 2019, using ProQuest Dialog. The reviews were registered in PROSPERO (CRD42017020026) and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was 30 day mortality; secondary outcomes were length of hospital stay and adverse neurological events. Forest plots with random effects meta-analysis to provide odds ratios (OR) were used for primary assessment. Results For TEVAR, seven studies were identified, including 2758 women and 4674 men; of these studies six were eligible for the primary outcome of 30 day mortality, including 1756 women and 2619 men. There were 94/1756 deaths in women and 82/2619 deaths in men, yielding a pooled 30 day mortality of 5% (95% confidence interval [CI] 3–7) in women and 3% (95% CI 2–4) in men (OR 1.75, 95% CI 1.29–2.38). Length of hospital stay was longer in women, with a standardised mean difference of 0.3 days (95% CI 0.14–0.47; six studies): meta-regression analysis did not identify the slightly older age of women as significant factor in these differences. Stroke rate was not different between the sexes. For open repair only a single study, with national coverage, was identified: this study reported similar 30 day mortality in men and women. Conclusions In the management of intact degenerative descending TAAs, 30 day mortality after TEVAR appears to be much higher in women than men with no reasons for this difference identified. However, for open repair there is a lack of contemporary evidence owing to insufficient recent data.

Introduccion : la anemia preoperatoria en cirugia cardiovascular viene en incremento a nivel global. Tiene una fuerte asociacion con la realizacion de transfusiones sanguineas e incremento de la morbimortalidad. En Colombia no se encuentran estudios que evidencien esta problematica a pesar de la importancia que tiene en el pronostico y en el desenlace postoperatorio. Objetivo : determinar la prevalencia de anemia previa a cirugia cardiovascular programada, la cantidad de transfusiones sanguineas postoperatorias de concentrado globular realizadas y su asociacion con la anemia, en la Institucion Prestadora de Salud (IPS) Clinica San Rafael de Pereira durante junio de 2015 a junio de 2016. Metodo : estudio descriptivo de corte transversal analitico con 129 pacientes sometidos a cirugia cardiovascular programada. El analisis de datos se realizo mediante Microsoft Excel 2013 y el software Stata 14. Resultados : se obtuvo una prevalencia de anemia previa a cirugia cardiovascular programada de 39,5 %. En el grupo de pacientes anemicos fueron transfundidos el 58,8 %. Se encontro asociacion entre la anemia y la realizacion de transfusiones sanguineas (IC 95 %: 0,17-0,82). Conclusiones : estos resultados deben llevar a la implementacion de estrategias para el adecuado manejo de la anemia preoperatoria en estos pacientes. Abstract Introduction : preoperative anemia in cardiovascular surgery is increasing globally. It has a strong association with blood transfusion and increased morbidity and mortality. In Colombia, there are no studies that show this problem despite the importance of prognosis and postoperative outcome. Objective : to determine the prevalence of anemia prior to scheduled cardiovascular surgery, the number of postoperative blood transfusions of globular concentrate performed and its association with anemia at the “Institucion Prestadora de Salud (IPS) Clinica San Rafael” of Pereira between June2015 and June 2016. Method : cross-sectional descriptive study. A population of 129 patients undergoing scheduled cardiovascular surgery was selected. Data analysis was performed using Microsoft Excel 2013 and Stata 14 software. Results : a prevalenceof anemia prior to scheduled cardiovascular surgery was obtained of 39.5 %. Among the anemic patients, 58.8 % of the patients were transfused. An association was found between anemia and blood transfusion CI: 95 %: 0.17-0.82. Conclusion :these results must carry out the implementation of strategies for the proper management of preoperative anemia in these patients. DOI: http://dx.doi.org/10.21615/cesmedicina.31.2.2

The relationship between preoperative anemia and in-hospital mortality has not been investigated in the pediatric surgical population. We hypothesized that children with preoperative anemia undergoing noncardiac surgery may have an increased risk of in-hospital mortality.We identified all children between 1 and 18 years of age with a recorded preoperative hematocrit (HCT) in the 2012, 2013, and 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pediatric databases. The endpoint was defined as the incidence of in-hospital mortality. Children with preoperative anemia were identified based on their preoperative HCT. Demographic and surgical characteristics, as well as comorbidities, were considered potential confounding variables in a multivariable logistic regression analysis. A sensitivity analysis was performed using propensity-matched analysis.Among the 183,833 children included in the 2012, 2013, and 2014 ACS NSQIP database, 74,508 had a preoperative HCT recorded (41%). After exclusion of all children1 year of age (n = 12,063), those with congenital heart disease (n = 8943), and those who received a preoperative red blood cell (RBC) transfusion (n = 1880), 12,551 (24%) children were anemic, and 39,071 (76%) were nonanemic. The median preoperative HCT was 33% (interquartile range, 31-35) in anemic children, and 39% (interquartile range, 37-42) in nonanemic children (P.001). Using multivariable logistic regression analysis, and after adjustment for RBC transfusion (OR, 2.13; 95% CI, 1.39-3.26; P.001), we observed that preoperative anemia was associated with higher odds for in-hospital mortality (OR, 2.17; 95% CI, 1.48-3.19; P.001). After propensity matching, the presence of anemia was also associated with higher odds of in-hospital mortality (OR, 1.75; 95% CI, 1.15-2.65; P = .004).Our study demonstrates that children with preoperative anemia are at increased risk for in-hospital mortality. Further studies are needed to assess whether the correction of preoperative HCT, through the development of a patient blood management program, improves patient outcomes or simply reduces the need for transfusions.

Background Preoperative anemia is present in 20% of total joint arthroplasty patients. Current preoperative treatment options, including iron supplementation (FE) and erythropoietin (EPO), are expensive. Tranexamic acid (TXA) has been adopted as an intraoperative adjunct to decrease blood loss. Our hypothesis is that TXA is a cost-effective treatment compared to FE and EPO in anemic patients. Methods In this study, a cost analysis was performed, comparing the material costs of TXA and packed red blood cells (PRBCs) to the theoretical administration and material costs of FE and EPO per standard preoperative anemia protocol. Results A total of 243 patients were included in the study. Of this group, 18.5% (45/243) had preoperative anemia. The rate of transfusion was 6.7% (3/45), and 5 units of PRBCs was transfused. The combined cost of TXA and PRBCs was $5317.08. Even assuming a best-case scenario with FE or EPO treatment without a postoperative PRBC requirement, the cost of treatment would range from 2 to 17 times more than treatment with TXA. An additional 50 units of PRBC (1.1 units per patient) would need to be transfused for the cost of TXA treatment to be equivalent to FE or EPO treatment. Conclusion Tranexamic acid is significantly less expensive than FE or EPO as a treatment option for total joint arthroplasty patients presenting with preoperative anemia. It is a cost-effective adjunct for limiting transfusion rates in this patient population. We recommend that new preoperative anemia levels that necessitate preoperative intervention be established.