The Effect of Preoperative Anemia on Hiatal Hernia Surgery and Postoperative Complications

Abstract

Aim: Anemia is associated with increased mortality and morbidity in all patients undergoing surgery. This study aimed to reveal to what extent anemia caused postoperative complications before hiatal hernia surgery. Material and Methods: One hundred and ninety-two patients operated for hiatal hernia in our clinic between 2015 and 2019 were analyzed retrospectively. Patients were compared according to demographics, preoperative laboratory values, preoperative Charlson comorbidity index score, hiatal hernia type, postoperative intensive care requirement, presence of postoperative complications, Clavien-Dindo score, blood transfusion need, and length of hospital stay. Results: Of the patients, 109 were female and 83 were male. The mean age was 50.1±9.1 years. Fifty-four (28.2%) of the patients were in the anemic group, and 138 (71.8%) were in the non-anemic group. There was no statistically significant difference between the groups in terms of gender distribution (p=0.663). When the groups were compared in terms of age distribution, it was found that the anemic group was older than the non-anemic group and the difference was statistically significant (p<0.001). There was a significant difference between the groups in terms of the postoperative complications rate and it was more common in the anemic group (p<0.001). There was a significant difference between the groups in terms of the need for intensive care and blood transfusion in the postoperative period (p=0.020, p<0.001, respectively). Conclusion: Preoperative anemia increases postoperative complications in hiatal hernia surgery. Therefore, the presence of anemia should be investigated before hiatal hernia surgery and patients with anemia should be followed up closely postoperatively.

Keywords

• anemia
• hiatal hernia
• morbidity
• mortality

Preoperatif Aneminin Hiatal Herni Cerrahisi ve Postoperatif Komplikasyonlara Etkisi

Abstract

Amaç: Anemi, cerrahi geçiren tüm hastalarda artmış mortalite ve morbidite ile ilişkilidir. Bu çalışmada, hiatal herni cerrahisi öncesi aneminin ne ölçüde postoperatif komplikasyonlara neden olduğunu ortaya koymak amaçlandı. Gereç ve Yöntemler: Kliniğimizde, 2015 ve 2019 yılları arasında hiatal herni nedeniyle ameliyat edilmiş olan hastalar geriye dönük olarak incelendi. Hastalar demografik, preoperatif laboratuvar değerleri, preoperatif Charlson komorbidite indeksi skoru, hiatal herni tipi, postoperatif yoğun bakım gereksinimi, postoperatif komplikasyon varlığı, Clavien-Dindo skoru, kan transfüzyon ihtiyacı ve hastanede kalış süresi açısından karşılaştırıldı. Bulgular: Hastaların 109’u kadın ve 83’ü erkek idi. Yaş ortalaması 50,1±9,1 yıl idi. Hastaların 54'ü (%28,2) anemik grupta ve 138'i (%71,8) ise anemik olmayan grupta idi. Cinsiyet dağılımı açısından gruplar arasında istatistiksel olarak anlamlı bir fark yoktu (p=0,663). Gruplar yaş dağılımı açısından karşılaştırıldığında, anemik grubun anemik olmayan gruba göre daha yaşlı olduğu ve bu farkın istatistiksel olarak da anlamlı olduğu saptandı (p<0,001). Postoperatif komplikasyon oranı açısından gruplar arasında anlamlı bir fark vardı ve anemik grupta daha sık olduğu görüldü (p<0,001). Postoperatif dönemde yoğun bakım ünitesi ve kan transfüzyonu ihtiyacı açısından da gruplar arasında anlamlı bir fark vardı (sırasıyla p=0,020, p<0,001). Sonuç: Preoperatif anemi, hiatal herni cerrahisinde postoperatif komplikasyonları arttırır. Bu nedenle, hiatal herni ameliyatı öncesi anemi varlığı araştırılmalı ve anemisi olan hastalar postoperatif dönemde yakın takip edilmelidir.

Keywords

• anemi
• hiatal herni
• morbidite
• mortalite

References

1. Yu HX, Han CS, Xue JR, Han ZF, Xin H. Esophageal hiatal hernia: risk, diagnosis, and management. Expert Rev Gastroenterol Hepatol. 2018;12(4):319-29.
2. Siegal SR, Dolan JP, Hunter JG. Modern diagnosis and treatment of hiatal hernias. Langenbecks Arch Surg. 2017;402(8):1145-51.
3. Dellaportas D, Papaconstantinou I, Nastos C, Karamanolis G, Theodosopoulos T. Large paraesophageal hiatus hernia: is surgery mandatory? Chirurgia (Bucur). 2018;113(6):765-71.
4. Clapp B, Hamdan M, Mandania R, Kim J, Gamez J, Hornock S, et al. Is fundoplication necessary after paraesophageal hernia repair? A meta-analysis and systematic review. Surg Endosc. 2022;36(8):6300-11.
5. Bisogni D, Valeri A, Talamucci L, Manetti R, Giordano ABF, Ardu M, et al. Life-threatening bleeding for a large cameron ulcer. A novel description of a tailored-surgical strategy: report of a case and literature overview. G Chir. 2019;40(5):398-404.
6. Verhoeff K, Dang JT, Deprato A, Kung JY, Switzer NJ, Birch DW, et al. Surgical management of hiatal hernia vs medical therapy to treat bleeding Cameron lesions: a systematic review and meta-analysis. Surg Endosc. 2021;35(12):7154-62.
7. Chevrollier GS, Brown AM, Keith SW, Szewczyk J, Pucci MJ, Chojnacki KA, et al. Preoperative anemia: a common finding that predicts worse outcomes in patients undergoing primary hiatal hernia repair. Surg Endosc. 2019;33(2):535-42.
8. Whitehead-Clarke T, Beynon V, Banks J, Karanjia R, Mudera V, Windsor A, et al. A systematic review examining the experimental methodology behind in vivo testing of hiatus hernia and diaphragmatic hernia mesh. J Gastrointest Surg. 2022;26(3):684-92.

9. Garcia-Casal MN, Pasricha SR, Sharma AJ, Peña-Rosas JP. Use and interpretation of hemoglobin concentrations for assessing anemia status in individuals and populations: results from a WHO technical meeting. Ann N Y Acad Sci. 2019;1450(1):5-14.
10. Kim P, Turcotte J, Park A. Hiatal hernia classification-Way past its shelf life. Surgery. 2021;170(2):642-3.
11. Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson comorbidity index: a critical review of clinimetric properties. Psychother Psychosom. 2022;91(1):8-35.
12. Guissé NF, Stone JD, Keil LG, Bastrom TP, Erickson MA, Yaszay B, et al. Modified Clavien-Dindo-sink classification system for adolescent idiopathic scoliosis. Spine Deform. 2022;10(1):87-95.
13. Muñoz M, Gómez-Ramírez S, Martín-Montañez E, Auerbach M. Perioperative anemia management in colorectal cancer patients: a pragmatic approach. World J Gastroenterol. 2014;20(8):1972-85.
14. Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and management. Blood. 2018;131(5):505-14.
15. Tan CHN, Kim G, So J, Shabbir A. Single-incision laparoscopic transgastric underrunning and closure of Cameron ulcers in acute gastrointestinal bleeding. J Gastrointest Surg. 2018;22(3):553-6.
16. Cheverie JN, Lam J, Neki K, Broderick RC, Lee AM, Matsuzaki T, et al. Paraesophageal hernia repair: a curative consideration for chronic anemia? Surg Endosc. 2020;34(5):2243-7.
17. Addo A, Broda A, Reza Zahiri H, Brooks IM, Park A. Resolution of anemia and improved quality of life following laparoscopic hiatal hernia repair. Surg Endosc. 2020;34(7):3072-8.
18. Hourani C, Carlin AM, Hammoud ZT, Velanovich V. Prevalence and resolution of anemia with paraesophageal hernia repair. J Gastrointest Surg. 2012;16(10):1817-20.
19. Dietrich CG, Hübner D, Heise JW. Paraesophageal hernia and iron deficiency anemia: Mechanisms, diagnostics and therapy. World J Gastrointest Surg. 2021;13(3):222-30.
20. Wang CQ, Tran T, Montera B, Karlnoski R, Feldman J, Albrink MH, et al. Symptomatic, radiological, and quality of life outcome of paraesophageal hernia repair with urinary bladder extracellular surgical matrix: comparison with primary repair. Surg Laparosc Endosc Percutan Tech. 2019;29(3):182-6.
21. Che F, Nguyen B, Cohen A, Nguyen NT. Prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis. 2013;9(6):920-4.
22. Chevrollier GS, Brown AM, Keith SW, Szewczyk J, Pucci MJ, Chojnacki KA, et al. Preoperative anemia: a common finding that predicts worse outcomes in patients undergoing primary hiatal hernia repair. Surg Endosc. 2019;33(2):535-42.
23. Trastek VF, Allen MS, Deschamps C, Pairolero PC, Thompson A. Diaphragmatic hernia and associated anemia: response to surgical treatment. J Thorac Cardiovasc Surg. 1996;112(5):1340-4.
24. Michailidou M, Nfonsam VN. Preoperative anemia and outcomes in patients undergoing surgery for inflammatory bowel disease. Am J Surg. 2018;215(1):78-81.
25. Clark LN, Helm MC, Higgins R, Lak K, Kastenmeier A, Kindel T, et al. The impact of preoperative anemia and malnutrition on outcomes in paraesophageal hernia repair. Surg Endosc. 2018;32(11):4666-72.