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. 2020 Sep;35(9):1769-1776.
doi: 10.1007/s00384-020-03611-0. Epub 2020 Jun 2.

Impact of anaemia at discharge following colorectal cancer surgery

Rebecca C Dru  1   2 , Nathan J Curtis  1   3 , Emma L Court  1 , Catherine Spencer  1 , Sara El Falaha  1 , Godwin Dennison  1 , Richard Dalton  1 , Andrew Allison  1 , Jonathan Ockrim  1 , Nader K Francis  4   5   6
Affiliations

Impact of anaemia at discharge following colorectal cancer surgery

Rebecca C Dru et al. Int J Colorectal Dis. 2020 Sep.

Abstract

Objectives: Preoperative anaemia is common in patients with colorectal cancer and increasingly optimised prior to surgery. Comparably little attention is given to the prevalence and consequences of postoperative anaemia. We aimed to investigate the frequency and short- or long-term impact of anaemia at discharge following colorectal cancer resection.

Methods: A dedicated, prospectively populated database of elective laparoscopic colorectal cancer procedures undertaken with curative intent within a fully implemented ERAS protocol was utilised. The primary endpoint was anaemia at time of discharge (haemoglobin (Hb) < 120 g/L for women and < 135 g/L for men). Patient demographics, tumour characteristics, operative details and postoperative outcomes were captured. Median follow-up was 61 months with overall survival calculated with the Kaplan-Meier log rank method and Cox proportional hazard regression based on anaemia at time of hospital discharge.

Results: A total of 532 patients with median 61-month follow-up were included. 46.4% were anaemic preoperatively (cohort mean Hb 129.4 g/L ± 18.7). Median surgical blood loss was 100 mL (IQR 0-200 mL). Upon discharge, most patients were anaemic (76.6%, Hb 116.3 g/L ± 14, mean 19 g/L ± 11 below lower limit of normal, p < 0.001). 16.7% experienced postoperative complications which were associated with lower discharge Hb (112 g/L ± 12 vs. 117 g/L ± 14, p = 0.001). Patients discharged anaemic had longer hospital stays (7 [5-11] vs. 6 [5-8], p = 0.037). Anaemia at discharge was independently associated with reduced overall survival (82% vs. 70%, p = 0.018; HR 1.6 (95% CI 1.04-2.5), p = 0.034).

Conclusion: Anaemia at time of discharge following elective laparoscopic colorectal cancer surgery and ERAS care is common with associated negative impacts upon short-term clinical outcomes and long-term overall survival.

Keywords: Anaemia; Colorectal cancer; Outcomes; Postoperative.

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Conflict of interest statement

NKF serves as chair of the UK ERAS Society. All authors confirm they hold no financial declarations or conflicts of interest for this paper.

Figures

Fig. 1
Fig. 1
Boxplots displaying haemoglobin values for males and females (g/L). a Preoperative values in those with and without anaemic. b Corresponding values at time of discharge
Fig. 2
Fig. 2
Kaplan-Meier curves displaying overall survival for preoperative anaemia (p = 0.027), postoperative anaemia (p = 0.018) and those newly anaemic at time of discharge (p = 0.018). In all, anaemic is associated with reduced long-term survival
See this image and copyright information in PMC

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