Perioperative Blood Management of Preoperative Anemia Determines Long-Term Outcome in Patients with Pancreatic Surgery

Abstract

Background/Purpose

Anemia affects the postoperative course of patients undergoing a major surgical procedure. However, it remains unclear whether anemia has a different impact on the long-term outcome of patients with malignant or benign pancreatic disease.

Methods

A retrospective analysis of patients undergoing pancreatic surgery for pancreatic malignancies or chronic pancreatitis was conducted between January 2012 and June 2018 at the University Hospital Dresden, Germany. The occurrence of preoperative anemia and the administration of pre-, intra-, and postoperative blood transfusions were correlated with postoperative complications and survival data by uni- and multivariate analysis.

Results

A total of 682 patients were included with 482 (70.7%) undergoing surgical procedures for pancreatic malignancies. Univariate regression analysis confirmed preoperative anemia as a risk factor for postoperative complications > grade 2 according to the Clavien-Dindo classification. Multivariate regression analyses indicated postoperative blood transfusion as an independent risk factor for postoperative complications in patients with a benign (OR 20.5; p value < 0.001) and a malignant pancreatic lesion (OR 4.7; p value < 0.01). Univariate and multivariate analysis revealed preoperative anemia and pre-, intra-, and postoperative blood transfusions as independent prognostic factors for shorter overall survival in benign and malignant patients (p value < 0.001–0.01).

Conclusion

Preoperative anemia is a prevalent, independent, and adjustable factor in pancreatic surgery, which poses a significant risk for postoperative complications irrespective of the entity of the underlying disease. It should therefore be understood as an adjustable factor rather than an indicator of underlying disease severity.

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Author information

Affiliations

Authors

Contributions

Study conception and design: FO, RK, DA, SH, and BM

Acquisition of data: FO, RK, DA, SH, MD, CK, and TW

Analysis and interpretation of data: FO, RK, DA, SH, MD, BM, UB, JW, CK, and TW

Writing of manuscript: FO, RK, DA, SH, MD, BM, UB, CK, TW, and JW with input and final approval of all authors

Corresponding author

Correspondence to C. Kahlert.

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Previous Publication

None of the information contained in this manuscript, either in part or in whole, has been published elsewhere. Furthermore, this manuscript is not under consideration for publication in any other journal either in part or in whole.

Study Location

The study was carried out at the Department for Visceral, Thoracic and Vascular Surgery at the University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany.

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The authors declare no competing interest.

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Supplementary Information

Supplementary Fig. 1:
figure2

Kaplan–Meier analysis for patients with a benign disease. (a) Kaplan–Meier analysis for patients with and without a preoperative anemia. Patients with preoperative anemia had a significantly (p-value < 0.01) shorter OS of 18 months. (b) Kaplan–Meier analysis adjusted for patients with and without a preoperative blood transfusion. Patients with a preoperative blood transfusion had a significantly (p-value < 0.001) shorter OS of 64 months. (c) Kaplan–Meier analysis adjusted for patients with and without a preoperative blood transfusion. Patients with a intraoperative blood transfusion had a significantly (p-value = 0.01) shorter OS of 25 months. (d) Kaplan–Meier analysis adjusted for patients with and without a preoperative blood transfusion. Patients with a postoperative blood transfusion had a significantly (p-value < 0.001) shorter OS of 31 months. (PNG 503 kb)

Supplementary Fig. 2:
figure3

Kaplan–Meier analysis for patients with a malignant disease. (a) Kaplan–Meier analysis for patients with and without a preoperative anemia. Patients with preoperative anemia had a significantly (p-value < 0.001) shorter OS of 13 months. (b) Kaplan–Meier analysis adjusted for patients with and without a preoperative blood transfusion. Patients with a preoperative blood transfusion had a significantly (p-value < 0.01) shorter OS of 23 months. (c) Kaplan–Meier analysis adjusted for patients with and without a preoperative blood transfusion. Patients with a intraoperative blood transfusion had a significantly (p-value < 0.001) shorter OS of 16 months. (d) Kaplan–Meier analysis adjusted for patients with and without a preoperative blood transfusion. Patients with a postoperative blood transfusion had a significantly (p-value < 0.001) shorter OS of 19 months. (PNG 571 kb)

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Oehme, F., Hempel, S., Knote, R. et al. Perioperative Blood Management of Preoperative Anemia Determines Long-Term Outcome in Patients with Pancreatic Surgery. J Gastrointest Surg (2021). https://doi.org/10.1007/s11605-021-04917-2

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Keywords

  • Pancreatic disease
  • Anemia
  • Pancreatic surgery
  • Transfusion
  • Long-term survival