Abstract
Background:Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations.Methods:The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression.Results:Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P < 0.001) and an increased 30-day morbidity rate of 25.9% versus 14.14% in non-anemic patients (P < 0.001). The 30-day morbidity rates for all patients undergoing cranial procedures were stratified by diagnosis: 26.5% aneurysm, 24.7% sellar tumor, 19.7% extra-axial tumor, 14.8% intra-axial tumor, 14.4% arteriovenous malformation, and 5.6% pain. Following multivariable regression, the 30-day mortality in anemic patients was threefold higher than in non-anemic patients (4.1% vs 1.3%; OR = 2.77; 95% CI: 1.65-4.66). The odds of postoperative morbidity in anemic patients were significantly higher than in non-anemic patients (OR = 1.29; 95% CI: 1.03-1.61). There was a significant difference in postoperative morbidity event odds with a hematocrit level above (OR = 1.07; 95% CI: 0.78-1.48) and below (OR = 2.30; 95% CI: 1.55-3.42) 33% [hemoglobin (Hgb) 11 g/dl].Conclusions:Preoperative anemia in elective cranial neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity.
Highlights
Anemia has been shown to be an independent risk factor of postoperative mortality and morbidity for several surgical procedures.[4,6,9,28,32,47] Anemia is of particular concern in clinical neurosurgery due to the substantial metabolic demand of neural tissue
Anemia is associated with worse outcomes in emergent cases for aneurysmal subarachnoid hemorrhage (SAH);[26] no similar association has been found in elective neurosurgical cases
Hematocrit values were collected on an average of 5.3 ± 8.6 days before surgery
Summary
Anemia has been shown to be an independent risk factor of postoperative mortality and morbidity for several surgical procedures.[4,6,9,28,32,47] Anemia is of particular concern in clinical neurosurgery due to the substantial metabolic demand of neural tissue. The effect of anemia on overall short‐term mortality and morbidity following cranial surgery remains uncertain. Preoperative anemia can exacerbate the clinical manifestations of significant intraoperative blood loss, which may range from 50 to 4300 ml[48] in cranial surgery.[26,40] With over 574,000 cranial neurosurgical procedures performed in the United States each year,[37] it is important to assess preoperative anemia as a risk factor for morbidity and mortality. Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations
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