From the Journals

Anemia in hiatal hernia patients doubled postop complications risk



Anemia is known to be a common condition in patients undergoing hiatal hernia repair (HHR), but it turns out to be associated with elevated risk of postoperative complications, according to findings published in Surgical Endoscopy.

In a retrospective study of 263 patients who underwent HHR, 27% were anemic. Anemia in these patients was associated with 2.6-fold greater odds of postoperative complications, reported Guillaume S. Chevrollier, MD, of the department of surgery at Jefferson Medical College, Philadelphia, and his coauthors.

Investigators identified 263 patients for study who underwent HHR between January 2011 and April 2017. Preoperative data included a full physical examination, chest x-ray, esophagogastroduodenoscopy, esophageal manometry, 24-hour pH study, and routine blood work.

Patient data were also assessed for identification of Cameron lesions, defined as either linear erosions or ulcers present at the diaphragmatic hiatus. Baseline data collected for analysis included age, sex, body mass index, Charlson Comorbidity Index, hernia type, hernia size, surgical approach, and urgency of repair.

Preoperative anemia was defined as serum hemoglobin levels less than 13 mg/dL in men and less than 12 mg/dL in women, in accordance with World Health Organization criteria. Outcomes of anemic and nonanemic patients were compared and included measures such as estimated blood loss, operative times, need for blood transfusion, intensive care unit admission, and postoperative complications. Postoperative complications were assessed for severity using the Clavien-Dindo Scale, Dr. Chevrollier and his colleagues wrote.

In total, 70 patients (27%) were anemic before their hernia repair surgery. A majority of patients (54%) were aged 65 years or older, of whom 29% were anemic. Large hernias were most common (60%), followed by moderate size (18%), giant (14%), and small (8%).

Sixty-four patients (24%) developed postoperative complications. Among anemic patients, 41% developed one or more complications, compared with just 18% of nonanemic patients (P less than .01). Anemia was associated with 2.6-fold greater odds of postoperative complications in adjusted multivariable analysis (odds ratio, 2.57; 95% confidence interval, 1.36-4.86; P less than .01), the authors reported.

“Heightened awareness for the presence and the implications of preoperative anemia in patients undergoing HHR is necessary,” the authors wrote. “Consideration for treatment of anemia prior to elective repair is likely warranted.”

No disclosures or conflicts of interest were reported.

SOURCE: Chevrollier G et al. Surg Endosc. 2018 Jul 11. doi: 10.1007/s00464-018-6328-4.

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