Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

Mohamad Bydon, Nicholas B. Abt, Mohamed Macki, Henry Brem, Judy Huang, Ali Bydon, Rafael J Tamargo

Research output: Contribution to journalArticle

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 stratifed 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.

Original languageEnglish (US)
Article number143754
JournalSurgical Neurology International
Volume5
Issue numberSupplement
DOIs
StatePublished - 2014

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Neurosurgery
Anemia
Morbidity
Odds Ratio
Mortality
Hematocrit
Hemoglobins
Neoplasms
Arteriovenous Malformations
Wound Infection
Operating Rooms
Quality Improvement
Respiratory Tract Infections
Nervous System
Aneurysm
Logistic Models
Databases
Kidney
Pain

Keywords

  • Anemia
  • Cranial
  • Hematocrit
  • Hemoglobin
  • National surgical quality improvement program
  • Neurosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery. / Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

In: Surgical Neurology International, Vol. 5, No. Supplement, 143754, 2014.

Research output: Contribution to journalArticle

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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 stratifed 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.",
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T1 - Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

AU - Bydon, Mohamad

AU - Abt, Nicholas B.

AU - Macki, Mohamed

AU - Brem, Henry

AU - Huang, Judy

AU - Bydon, Ali

AU - Tamargo, Rafael J

PY - 2014

Y1 - 2014

N2 - 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 stratifed 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.

AB - 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 stratifed 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.

KW - Anemia

KW - Cranial

KW - Hematocrit

KW - Hemoglobin

KW - National surgical quality improvement program

KW - Neurosurgery

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