Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA.
Surg Endosc. 2023 Nov;37(11):8708-8713. doi: 10.1007/s00464-023-10302-8. Epub 2023 Jul 31.
Iron deficiency anemia is a common paraesophageal hernia (PEH) symptom and may improve after repair. When present, anemia has also been proposed to be associated with an increase in length of hospital stay, morbidity, and mortality after PEH repair. This study aimed to determine anemia-related factors in patients with PEH, the rate of anemia resolution after PEH repair, and the risk of anemia recurrence when repair failed.
We included patients who received a PEH repair between June 2019 and June 2020 and had 24 months of postoperative follow-up. Demographics and comorbidities were recorded. Anemia was defined as pre-operative hemoglobin values < 12.0 for females and < 13.0 for males, or if patients were receiving iron supplementation. Anemia resolution was determined at 6 months post-op. Length of hospital stay, morbidity, and mortality was recorded. Logistic regression and ANCOVA were used for binary and continuous outcomes respectively.
Of 394 patients who underwent PEH repair during the study period, 101 (25.6%) had anemia before surgery. Patients with pre-operative anemia had larger hernia sizes (6.55 cm ± 2.77 vs. 4.34 cm ± 2.50; p < 0.001). Of 68 patients with available data by 6 months after surgery, anemia resolved in 36 (52.9%). Hernia recurred in 6 patients (16.7%), 4 of whom also had anemia recurrence (66.7%). Preoperative anemia was associated with a higher length of hospital stay (3.31 days ± 0.54 vs 2.33 days ± 0.19 p = 0.046) and an increased risk of post-operative all-cause mortality (OR 2.7 CI 1.08-6.57 p = 0.05). Fundoplication type (p = 0.166), gastropexy, or mesh was not associated with an increased likelihood of resolution (OR 0.855 CI 0.326-2.243; p = 0.05) (OR 0.440 CI 0.150-1.287; p = 0.05).
Anemia occurs in 1 out of 4 patients with PEH and is more frequent in patients with larger hernias. Anemia is associated with a longer hospital stay and all-cause mortality after surgery. Anemia recurrence coincided with hernia recurrence in roughly two-thirds of patients.
缺铁性贫血是食管裂孔疝（PEH）的常见症状，在修复后可能会改善。当存在贫血时，还提出贫血与 PEH 修复后住院时间延长、发病率和死亡率增加有关。本研究旨在确定 PEH 患者的贫血相关因素、PEH 修复后贫血的缓解率以及修复失败时贫血复发的风险。
我们纳入了 2019 年 6 月至 2020 年 6 月期间接受 PEH 修复并进行了 24 个月术后随访的患者。记录了人口统计学和合并症。贫血定义为女性术前血红蛋白值<12.0，男性<13.0，或患者正在接受铁补充治疗。术后 6 个月确定贫血缓解情况。记录住院时间、发病率和死亡率。使用逻辑回归和协方差分析分别用于二项和连续结果。
在研究期间接受 PEH 修复的 394 名患者中，有 101 名（25.6%）在手术前患有贫血。术前贫血患者的疝大小更大（6.55cm±2.77 与 4.34cm±2.50；p<0.001）。术后 6 个月有 68 名患者有可用数据，其中 36 名（52.9%）贫血缓解。疝复发 6 例（16.7%），其中 4 例（66.7%）也出现贫血复发。术前贫血与住院时间延长（3.31 天±0.54 与 2.33 天±0.19，p=0.046）和术后全因死亡率增加（OR 2.7，CI 1.08-6.57，p=0.05）相关。胃底折叠术类型（p=0.166）、胃固定术或网片与缓解的可能性增加无关（OR 0.855，CI 0.326-2.243；p=0.05）（OR 0.440，CI 0.150-1.287；p=0.05）。
PEH 患者中有 1/4 出现贫血，且在疝较大的患者中更为常见。贫血与术后住院时间延长和全因死亡率增加有关。贫血复发与疝复发在大约三分之二的患者中同时发生。
