Liver resections and pre-operative anaemia: Optimising patients in the peri-operative settings to reduce morbidity and mortality

Abstract

Background: Preoperative anaemia and intraoperative blood transfusion are associated with an increased risk of morbidities and mortalities after hepatectomy. This study aims to explore the incidence of preoperative anaemia and blood transfusion, and the effect on morbidity and mortality in patients undergoing hepatectomy. Methods: A retrospective review of all major hepatectomy cases performed between August 2017 to July 2018 at the regional hepatobillary unit in Northern Ireland was conducted. Demographics, pre- and post-operative haemoglobin levels (up to day 5 post surgery), preoperative iron and ferritin levels, intraoperative transfusion, 30-day mortality and major morbidity were recorded. The World Health Organisation definition of anaemia was applied, where haemoglobin level is <130g/L in men and <120g/L in women. Results: 82 cases of hepatectomies were reviewed, of which 45 were male and 37 female. The average age was 62 years. Mean length of stay was 9 days (2-42 days). Preoperative anaemia was observed in 30% (n=25), of which 76% (n=19) had an altered iron profile. 17% (n=14) were transfused intraoperatively and 5% (n=4) within 10 days postoperatively. 39% (n=7) of those transfused were anaemic preoperatively. 11% (n=9) required long term oral ferritin replacement post-surgery. The median percentage haemoglobin level drop day 1 post-surgery was 12.8%, and day 5 post-surgery was 24.3%. Massive haemorrhage protocol was implemented intraoperatively in 7% of the cases (n=6). Ninety-day mortality rate was 6% (n=5), of which 80% were anaemic pre-operatively. Conclusion: This review highlights the high incidence of preoperative anaemia in our cohort of hepatectomy cases. A high proportion of these cases had an altered iron profile which could have been corrected prior to surgery. Our study highlights the importance of vigilance in the preoperative setting to optimise patients’ preoperative haemoglobin and iron levels to reduce potential need for intraoperative transfusion and potentially reduce risk of mortality and morbidity.