1
|
Tyan P, Taher A, Carey E, Sparks A, Radwan A, Amdur R, Tamim H, Gu A, Robinson H, Moawad GN. The effect of anemia severity on postoperative morbidity among patients undergoing laparoscopic hysterectomy for benign indications. Acta Obstet Gynecol Scand 2019; 99:112-118. [PMID: 31449328 DOI: 10.1111/aogs.13718] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION One-third of non-pregnant women worldwide are anemic.1 Anemia is a known independent risk factor for postoperative morbidity.2 Given that the vast majority of hysterectomies are not performed in the emergency setting, we designed this study to evaluate the effect of preoperative anemia on postoperative morbidity following laparoscopic hysterectomy performed for benign indications. Our main goal is to encourage surgeons to use anemia-corrective measures before surgery when feasible. MATERIAL AND METHODS Retrospective cohort study of 98 813 patients who underwent a laparoscopic hysterectomy between 2005 and 2016 for benign indications identified through the American College of Surgeons National Surgical Quality Improvement Program. Anemia was examined as a function of hematocrit and was analyzed as an ordinal variable stratified by anemia severity as mild, moderate or severe. Associations between preoperative anemia and patient demographics, preoperative comorbidities and postoperative outcomes were evaluated using univariate analyses. Multivariable logistic regression models were used to identify independent associations between hematocrit level and postoperative outcomes after adjusting for confounding covariates. At the multivariable logistic regression level, anemia severity was analyzed using hematocrit as a continuous variable to assess the independent association between each 5% decrease in hematocrit level and several postoperative morbidities. RESULTS Of the 98 813 patients who met our inclusion and exclusion criteria, 19.5% were anemic. A lower preoperative hematocrit was associated with higher body mass index, younger age, Black or African American race, longer operative times, and multiple other medical comorbidities. After appropriate regression modeling, anemia was identified as an independent risk factor for extended length of stay, readmission and composite morbidity after surgery. CONCLUSIONS Preoperative anemia is common among patients undergoing laparoscopic hysterectomy. Preoperative anemia increases patients' risk for multiple postoperative comorbidities. Given that most hysterectomies are performed in the elective setting, gynecologic surgeons should consider the use of anemia-corrective measures to minimize postoperative morbidity.
Collapse
Affiliation(s)
- Paul Tyan
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ali Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Erin Carey
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew Sparks
- Department of Surgery, School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - Amr Radwan
- Department of Internal Medicine, St. Elizabeth's Medical Center, Brighton, MA, USA
| | - Richard Amdur
- Department of Surgery, School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Alex Gu
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Hannah Robinson
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Gaby N Moawad
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, The George Washington University, Washington, DC, USA
| |
Collapse
|
2
|
Sunwoo W, Lee DY, Lee JY, Lee M, Kang Y, Park MH, Kim YH. Characteristics of tinnitus found in anemia patients and analysis of population-based survey. Auris Nasus Larynx 2018; 45:1152-1158. [DOI: 10.1016/j.anl.2018.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/05/2018] [Accepted: 04/06/2018] [Indexed: 12/17/2022]
|
3
|
Chai C, Liu S, Fan L, Liu L, Li J, Zuo C, Qian T, Haacke EM, Shen W, Xia S. Reduced deep regional cerebral venous oxygen saturation in hemodialysis patients using quantitative susceptibility mapping. Metab Brain Dis 2018; 33:313-323. [PMID: 29249064 DOI: 10.1007/s11011-017-0164-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/29/2017] [Indexed: 01/07/2023]
Abstract
Cerebral venous oxygen saturation (SvO2) is an important indicator of brain function. There was debate about lower cerebral oxygen metabolism in hemodialysis patients and there were no reports about the changes of deep regional cerebral SvO2 in hemodialysis patients. In this study, we aim to explore the deep regional cerebral SvO2 from straight sinus using quantitative susceptibility mapping (QSM) and the correlation with clinical risk factors and neuropsychiatric testing. 52 hemodialysis patients and 54 age-and gender-matched healthy controls were enrolled. QSM reconstructed from original phase data of 3.0 T susceptibility-weighted imaging was used to measure the susceptibility of straight sinus. The susceptibility was used to calculate the deep regional cerebral SvO2 and compare with healthy individuals. Correlation analysis was performed to investigate the correlation between deep regional cerebral SvO2, clinical risk factors and neuropsychiatric testing. The deep regional cerebral SvO2 of hemodialysis patients (72.5 ± 3.7%) was significantly lower than healthy controls (76.0 ± 2.1%) (P < 0.001). There was no significant difference in the measured volume of interests of straight sinus between hemodialysis patients (250.92 ± 46.65) and healthy controls (249.68 ± 49.68) (P = 0.859). There were no significant correlations between the measured susceptibility and volume of interests in hemodialysis patients (P = 0.204) and healthy controls (P = 0.562), respectively. Hematocrit (r = 0.480, P < 0.001, FDR corrected), hemoglobin (r = 0.440, P < 0.001, FDR corrected), red blood cell (r = 0.446, P = 0.003, FDR corrected), dialysis duration (r = 0.505, P = 0.002, FDR corrected) and parathyroid hormone (r = -0.451, P = 0.007, FDR corrected) were risk factors for decreased deep regional cerebral SvO2 in patients. The Mini-Mental State Examination (MMSE) scores of hemodialysis patients were significantly lower than healthy controls (P < 0.001). However, the deep regional cerebral SvO2 did not correlate with MMSE scores (P = 0.630). In summary, the decreased deep regional cerebral SvO2 occurred in hemodialysis patients and dialysis duration, parathyroid hormone, hematocrit, hemoglobin and red blood cell may be clinical risk factors.
Collapse
Affiliation(s)
- Chao Chai
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Saifeng Liu
- The MRI Institute for Biomedical Research, N9A6T2, Waterloo, ON, Canada
| | - Linlin Fan
- Department of Prophylactic Inoculation and Statistics, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Lei Liu
- School of Graduates, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Jinping Li
- Department of Hemodialysis, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Chao Zuo
- School of Graduates, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Tianyi Qian
- MR Collaboration, Siemens Healthcare, Northeast Asia, Beijing, 100102, China
| | - E Mark Haacke
- Department of Radiology, Wayne State University, Detroit, MI, 48202, USA
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China.
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Tianjin, 300192, China.
| |
Collapse
|
4
|
Terp Fjederholt K, Svendsen LB, Mortensen FV. Perioperative blood transfusions increases the risk of anastomotic leakage after surgery for GEJ-cancer. Am J Surg 2017; 214:293-298. [PMID: 28259203 DOI: 10.1016/j.amjsurg.2017.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/11/2017] [Accepted: 01/19/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect of blood transfusions on the risk of anastomotic leakage (AL) in patients with gastro-esophageal-junction (GEJ) cancer. BACKGROUND The incidence of GEJ cancer is increasing in the western world. Surgery is the curative treatment of choice. AL increases mortality and morbidity, and increases the risk cancer reoccurrence. In colo-rectal surgery a relation between AL and blood transfusions have been demonstrated. METHOD The risk of AL in relation to blood transfusions was investigated in a cohort study. 253 consecutive patients undergoing surgery for GEJ cancer was included. Data was based on a prospective maintained database and analyzed using logistic regressions models adjusting for multiple confounders. RESULTS We found an increased risk of AL when blood was transfused OR: 3.47, (1.51; 7.99). This relation was consistent after adjustment for multiple confounders OR: 4.60, (1.29; 16.4). Increasing number of blood units did not increase risk of AL further. CONCLUSION We present data demonstrating a strong correlation between receiving blood transfusions and the risk of AL after surgery in GEJ cancers patients.
Collapse
Affiliation(s)
- Kaare Terp Fjederholt
- Department of Surgery, Section for Upper Gastrointestinal and Hepato-pancreato-biliary Surgery, Aarhus University Hospital, Denmark.
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Denmark
| | - Frank Viborg Mortensen
- Department of Surgery, Section for Upper Gastrointestinal and Hepato-pancreato-biliary Surgery, Aarhus University Hospital, Denmark
| |
Collapse
|