Key result
Preoperative anemia etiology was an independent predictor of survival after colorectal surgery, with iron deficiency anemia and anemia of inflammation associated with better 1-year survival (84.3% and 77.3%) compared to other anemia etiologies (69.1%).
Why the study?
Preoperative anemia is prevalent and linked to perioperative death in colorectal surgery, but whether the association between anemia and survival is determined by anemia severity alone or also by etiology was unclear.
Does the etiology of preoperative anemia affect postoperative survival in patients undergoing colorectal surgery?
Cohort (n=2,458)
No
Does the etiology of preoperative anemia affect postoperative survival in patients undergoing colorectal surgery?
Hazard Ratio: 1.423 (95% CI 1.041–1.945)
Absolute Event Rate: 84.3% vs 69.1%
p-value: p=0.027
Preoperative anemia etiology is an independent predictor of survival after colorectal surgery, with iron deficiency anemia having a better prognosis than anemia of inflammation or other etiologies.
Anemia etiology independently predicted survival beyond severity in this retrospective cohort; supports etiology-guided preoperative assessment but leaves causality and practice change open.
BACKGROUND: Anemia 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. OBJECTIVE: The 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. METHODS: To 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 <120 g/L in females and <130 g/L in males. The etiology of anemia was classified on the basis of serum iron parameters, as iron deficiency anemia, anemia of inflammation or other anemia etiologies. RESULTS: Preoperative 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. CONCLUSIONS: Anemia has a high prevalence among patients undergoing colorectal surgery and rational treatment requires early assessment of serum iron parameters and C-reactive protein.
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Bath et al. (2022) conducted a cohort in Colorectal surgery (n=2,458). Preoperative anemia etiology (iron deficiency vs. inflammation vs. other) vs. Other anemia etiologies was evaluated on 1-year survival (HR 1.423, 95% CI 1.041-1.945, p=0.027). Preoperative anemia etiology was an independent predictor of survival after colorectal surgery, with iron deficiency anemia and anemia of inflammation associated with better 1-year survival (84.3% and 77.3%) compared to other anemia etiologies (69.1%).
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