8459 Prevalence, Predictors and Hospital- and Surgeon-Level Variation of Preoperative Anemia: A Multi-Centre Retrospective Study

Abstract

<h3>Study Objective</h3> Evaluate prevalence, predictors, and hospital- and surgeon-level variation of preoperative anemia, a quality metric, prior to elective hysterectomy. <h3>Design</h3> Multi-center retrospective review. <h3>Setting</h3> 9 Ontario, Canada hospitals (6 academic, 3 community). <h3>Patients or Participants</h3> Patients undergoing elective hysterectomy from July 2016-December 2020. Patients with malignancy, invasive placentation and pregnancy were excluded. <h3>Interventions</h3> Primary outcome was preoperative anemia (hemoglobin <12 g/dL) within three months prior to surgery. <h3>Measurements and Main Results</h3> Patient, case and surgeon characteristics for those with and without anemia were recorded and bivariate comparisons between groups were completed. Linear mixed effects regression assessed associations between anemia and several patient and surgeon variables, and adjusted odds ratios (aORs) were reported. A multilevel model was created to calculate median odds ratios (MOR) to assess surgeon- and hospital-level variability in preoperative anemia rates. A total of 4557 hysterectomies by 113 surgeons at nine hospitals were included. One in five patients (909 patients, 19.9%) were anemic preoperatively. Several patient, case and surgeon characteristics were associated with preoperative anemia: Preoperative diagnosis of abnormal uterine bleeding (aOR 1.48, 95%CI 1.20-1.81, p<0.001); uterine weight in the two uppermost quartiles (aOR 2.41, 95%CI 1.71-3.38, p<0.001 and aOR 3.52, 95%CI 2.34-4.50, p<0.001, respectively); surgeon length of practice >11 years (aOR 1.66, 95%CI 1.29-2.12, p<0.001); and community practice (aOR 2.05, 95%CI 1.44-2.93, p<0.001). There was considerable variability in preoperative anemia rates among surgeons (MOR 1.29) and hospitals (MOR 1.54), suggesting that a patient had a 54% higher chance of preoperative anemia at one randomly selected hospital compared to another; and a 29% higher chance of being anemic if cared for by one surgeon compared to another. <h3>Conclusion</h3> Several factors are associated with preoperative anemia among hysterectomy patients and variation in preoperative anemia exists at both the hospital- and surgeon-level. Quality improvement initiatives aimed at surgeons with longer duration of practice and those at community hospitals may reduce variability.