Prevalence and risk factors of preoperative anemia in patients undergoing hysterectomy for gynecologic cancer.

Abstract

e18800 Background: Anemia is a common preoperative finding that is associated with increased morbidity and mortality in patients with gynecologic cancers. This study identified the prevalence and risk factors associated with anemia in women undergoing hysterectomy for gynecologic cancer. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2014 to 2020 for women above the age of 18 who underwent an open or minimally invasive hysterectomy and had a postoperative diagnosis of endometrial, cervical, ovarian, or fallopian tube cancer. Prevalence rates of anemia (hematocrit less than 30%) were calculated, and odds ratio (OR) with 95% confidence interval (CI) were estimated from logistic regression models adjusted for comorbidities. Results: A total of 62,708 patients were included in the analysis and 3351 (5.3%) had anemia. Mean hematocrit was 38.9 (SD 4.9). Overall, endometrial cancer was the most common diagnosis (73.1%) and mean age for all patients was 61.2 years (SD 12.1). Patients were predominantly non-Hispanic White (74.4%). Non-Hispanic Black patients were 1.98 (95% CI, 1.76 – 2.22) times at increased odds of anemia compared to non-Hispanic White patients. Similarly, Hispanic ethnicity was associated with increased odds of anemia compared to non-Hispanic White women (OR, 1.31; 95% CI, 1.14 – 1.50). Underweight patients had 1.64 (95% CI, 1.27 – 2.12) increased odds of anemia compared to normal weight patients. Compared to patients that underwent minimally invasive surgery, those that had an open abdominal hysterectomy were at over 2.7-fold increased odds (OR, 2.77; 95% CI, 2.53 – 3.04) of anemia. Those who reported greater than 10% loss of body weight in the last 6 months were 2.33 (95% CI, 5.06 – 6.81) times at increased odds of anemia. Other clinical factors associated with increased odds of anemia included metastatic cancer, American Society of Anesthesiologists (ASA) physical status classification score of 3 or more, and 2 or more comorbid conditions. Conclusions: There are multiple risk factors associated with preoperative anemia in patients undergoing hysterectomy for cancer. Identification of high-risk patients may help clinicians appropriately screen for and treat anemia prior to surgery.