Author: Eric Ramos
Preoperative anaemia in patients with sepsis undergoing exploratory laparotomy can lead to increased mortality, postoperative complications, and length of hospital stay, according to a study presented at the 2020 Virtual Meeting of the American Society of Anesthesiologists (ASA).
“The incidence of sepsis and septic shock, particularly in elective general surgery cases, can actually be quite high, ranging from 1% to 2%, and in emergency general surgery cases, the incidence can go as high as 4.5% to 5%,” said Rahul Chaturvedi, University of California San Diego School of Medicine, San Diego, California.
For the study, the researchers analysed data from the National Surgical Quality Improvement Program registry to identify patients aged 18 years and older who had preoperative sepsis and underwent an exploratory laparotomy between 2014 and 2016. Patients were stratified into 4 groups according to preoperative haematocrit levels: those with >30% haematocrit to less than polycythemic levels, those with <21%, those between 21% and 30%, and patients with polycythaemia (>48% in females and >52% in males). The primary outcome was 30-day mortality.
“The mortality rate was highest for patients with haematocrit levels <21% — with a mortality rate of 52% [P< .001 vs the other haematocrit cohorts],” said Chaturvedi. “The second highest was the group with haematocrit levels between 21% and 30%, with a mortality rate of 41%.”
After adjusting for confounders, such as gender, body mass index, and age, the odds of 30-day death was significantly increased for patients with preoperative haematocrit < 21% (odds ratio [OR] = 2.39; 95% confidence interval [CI], 1.28-4.49; P = .006) and for patients with in the 21% to 30% range (OR = 1.35; 95% CI, 1.05-1.72; P = .017) compared with patients with preoperative haematocrit of >30% and less than polycythemic ranges.
“Preoperative anaemia definitely has a profound impact on mortality, particularly in septic patients,” said Chaturvedi. “Surprisingly, transfusing these patients is actually associated with increased length of stay, postoperative infections, and prolonged ventilation. Certain studies have looked at incorporating iron, B12, folate, epoetin, and steroids, but the results are questionable at best, and right now, they are inconclusive.”
“What we do know is that early diagnosis can definitely improve mortality and allow for more time to titrate anticoagulation medications and treat preoperative anaemia,” he added. “Future studies need to be conducted to figure out what the best intervention is for patients with sepsis who have preoperative anaemia.”