AUTHOR=Xu Jing-Yong , Tian Xiao-Dong , Yang Yin-Mo , Song Jing-Hai , Wei Jun-Min 

TITLE=Preoperative Anemia Is a Predictor of Worse Postoperative Outcomes Following Open Pancreatoduodenectomy: A Propensity Score-Based Analysis

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.818805

DOI=10.3389/fmed.2022.818805

ISSN=2296-858X

ABSTRACT=Background: Preoperative anemia is a common clinical situation proved to be associated with severe outcomes in major surgery but not in pancreatic surgery alone. We aim to study the impact of preoperative anemia on morbidity and mortality in patients undergoing open pancreaticoduodenectomy and use propensity score matching (PSM) to balance the basal data and reduce bias.  
Methods: We analyze data of consecutive patients undergoing open pancreaticoduodenectomy with complete record of preoperative hemoglobin at two pancreatic centers in China between 2015 to 2019. We define anemia as hemoglobin less than 12g/dl for male and 11g/dl for female following Chinese criteria. We compare clinical and economic outcomes before and after PSM and use logistic regression analysis to assess correlation between variables and anemia. 
Results: The unmatched initial cohort consist of 517 patients. 148 cases (28.6%) are diagnosed as anemia at admission, and no case receives preoperative blood transfusion or anti-anemia therapy. After PSM, 126 cases are in each group. The rate of severe postoperative complications is significantly higher in anemia group than in normal group (43.7% versus 27.0%, P=0.006), among which the differences of prevalence of clinically relevant postoperative pancreatic fistula (31.0% versus 15.9%, P=0.005) and cardiac and cerebrovascular events (4.0% versus 0.0%, P=0.024) are the most significant. It costs more in the anemia group (26958.2±21671.9 versus 20987.7±10237.9 USD, P=0.013). Among anemic patients, ROC curve analysis shows the cut-off 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 shows that preoperative obstructive jaundice [OR 1.813, 95%CI (1.206-2.725), P=0.004] and pancreatic ductal adenocarcinoma [OR 1.861, 95%CI (1.178-2.939), P=0.008] were predictors of anemia. Among paired patients, preoperative anemia [OR 2.593, 95%CI (1.481-5.541), P=0.001] and malignant pathology [OR 4.266, 95%CI (1.597-11.395), P=0.004] are predictors of postoperative severe complications.
Conclusions: Preoperative anemia is a predictor of worse postoperative outcomes following open pancreatoduodenectomy and needs identified and treated.