Xu Jing-Yong, Tian Xiao-Dong, Yang Yin-Mo, Song Jing-Hai, Wei Jun-Min
Department of General Surgery, Department of Hepato-Bilio-Pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Department of General Surgery, Peking University First Hospital, Beijing, China.
Front Med (Lausanne). 2022 May 13;9:818805. doi: 10.3389/fmed.2022.818805. eCollection 2022.
Preoperative anemia is a common clinical situation proved to be associated with severe outcomes in major surgeries, but not in pancreatic surgery. We aim to study the impact of preoperative anemia on morbidity and mortality in patients undergoing open pancreatoduodenectomy and use propensity score matching (PSM) to balance the basal data and reduce bias.
We analyzed the data of consecutive patients undergoing open pancreatoduodenectomy with a complete record of preoperative hemoglobin, at two pancreatic centers in China between 2015 and 2019. Anemia is defined as hemoglobin less than 12 g/dl for male and 11 g/dl for female, following Chinese criteria. We compared clinical and economic outcomes before and after PSM and used logistic regression analysis to assess the correlation between variables and anemia.
The unmatched initial cohort consisted of 517 patients. A total of 148 cases (28.6%) were diagnosed with anemia at admission, and no case received a preoperative blood transfusion or anti-anemia therapy. After PSM, there were 126 cases in each group. The rate of severe postoperative complications was significantly higher in the anemia group than in the normal group (43.7% vs. 27.0%, = 0.006), among which the differences in prevalence of clinically relevant postoperative pancreatic fistula (CR-POPF) (31.0% vs. 15.9%, = 0.005) and cardiac and cerebrovascular events (4.0% vs. 0.0%, = 0.024) were the most significant. The costs involved were more in the anemia group (26958.2 ± 21671.9 vs. 20987.7 ± 10237.9 USD, = 0.013). Among anemic patients, receiver operating characteristic (ROC) curve analysis shows the cut-off value of hemoglobin, below which, patients are prone to suffer from major complications (104.5 g/l in male and 90.5 g/l in female). Among all patients, multivariate analysis showed that preoperative obstructive jaundice [odds ratio (OR) = 1.813, 95% confidence interval (CI) (1.206-2.725), = 0.004] and pancreatic ductal adenocarcinoma [OR = 1.861, 95% CI (1.178-2.939), = 0.008] were predictors of anemia. Among paired patients, preoperative anemia [OR = 2.593, 95% CI (1.481-5.541), = 0.001] and malignant pathology [OR = 4.266, 95% CI (1.597-11.395), = 0.004] were predictors of postoperative severe complications.
Preoperative anemia is a predictor of worse postoperative outcomes following open pancreatoduodenectomy and needs to be identified and treated.
术前贫血是一种常见的临床情况，已被证明与大手术的严重后果相关，但在胰腺手术中并非如此。我们旨在研究术前贫血对接受开放性胰十二指肠切除术患者的发病率和死亡率的影响，并使用倾向评分匹配（PSM）来平衡基础数据并减少偏差。
我们分析了2015年至2019年期间在中国两个胰腺中心接受开放性胰十二指肠切除术且术前血红蛋白记录完整的连续患者的数据。根据中国标准，贫血定义为男性血红蛋白低于12 g/dl，女性低于11 g/dl。我们比较了PSM前后的临床和经济结果，并使用逻辑回归分析评估变量与贫血之间的相关性。
未匹配的初始队列包括517例患者。共有148例（28.6%）患者入院时被诊断为贫血，且无一例接受术前输血或抗贫血治疗。PSM后，每组各有126例。贫血组术后严重并发症发生率显著高于正常组（43.7%对27.0%，P = 0.006），其中临床相关术后胰瘘（CR-POPF）（31.0%对15.9%，P = 0.005）和心脑血管事件（4.0%对0.0%，P = 0.024）的患病率差异最为显著。贫血组的相关费用更高（26958.2±21671.9美元对20987.7±10237.9美元，P = 0.013）。在贫血患者中，受试者工作特征（ROC）曲线分析显示血红蛋白的临界值，低于该值患者易发生主要并发症（男性为104.5 g/l，女性为90.5 g/l）。在所有患者中，多因素分析显示术前梗阻性黄疸[比值比（OR）=1.813，95%置信区间（CI）（1.206 - 2.725），P = 0.004]和胰腺导管腺癌[OR = 1.861，95% CI（1.178 - 2.939），P = 0.008]是贫血的预测因素。在配对患者中，术前贫血[OR = 2.593，95% CI（1.481 - 5.541），P = 0.001]和恶性病理[OR = 4.266，95% CI（1.597 - 11.395）），P = 0.004]是术后严重并发症的预测因素。
术前贫血是开放性胰十二指肠切除术后不良术后结局的预测因素，需要加以识别和治疗。
