PLoS ONE (Jan 2022)

Impact of preoperative anemia, iron-deficiency and inflammation on survival after colorectal surgery-A retrospective cohort study.

  • Messina Bath,
  • André Viveiros,
  • Benedikt Schaefer,
  • Sebastian Klein,
  • Lorenz M Pammer,
  • Sonja Wagner,
  • Andreas Lorenz,
  • Christopher Rugg,
  • Elisabeth Gasser,
  • Marijana Ninkovic,
  • Marlene Panzer,
  • Elke Pertler,
  • Dietmar Fries,
  • Herbert Tilg,
  • Guenter Weiss,
  • Verena Petzer,
  • Dietmar Öfner-Velano,
  • Heinz Zoller

DOI
https://doi.org/10.1371/journal.pone.0269309
Journal volume & issue
Vol. 17, no. 7
p. e0269309

Abstract

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BackgroundAnemia is present in up to two-thirds of patients undergoing colorectal surgery mainly caused by iron deficiency and inflammation. As anemia is associated with increased risk of perioperative death, diagnosis and treatment of preoperative anemia according to etiology have been recommended.ObjectiveThe aim of the present study was to assess if the association between anemia and survival in patients undergoing colorectal surgery was determined by the severity of anemia alone or also by anemia etiology.MethodsTo determine the prevalence of anemia and etiology, preoperative hematological parameters, C-reactive protein, ferritin and transferrin saturation were retrospectively assessed and correlated with outcome in a cohort of patients undergoing colorectal surgery between 2005 and 2019 at the University Hospital of Innsbruck. Anemia was defined as hemoglobin ResultsPreoperative anemia was present in 54% (1316/2458) of all patients. Anemia was associated with iron deficiency in 45% (134/299) and classified as anemia of inflammation in 32% (97/299) of patients with available serum iron parameters. The etiology of anemia was a strong and independent predictor of survival, where iron deficiency and anemia of inflammation were associated with better postoperative survival than other anemia etiologies. One year survival rates were 84.3%, 77.3% and 69.1% for patients with iron deficiency anemia, anemia of inflammation and other anemia types. Inflammation indicated by high C-reactive protein is a strong negative predictor of overall survival.ConclusionsAnemia has a high prevalence among patients undergoing colorectal surgery and rational treatment requires early assessment of serum iron parameters and C-reactive protein.