The role of preoperative anemia in patients undergoing colectomy for diverticular disease: does surgical urgency matter?

Purpose: Surgery especially in the emergent setting carries higher rates of morbidity and mortality. The aim of our study was to evaluate the impact of preoperative anemia on outcomes for patients undergoing colectomy for acute diverticulitis in both elective and emergent settings.

Methods: We performed a 4-year analysis of the ACS-NSQIP and included adult patients with acute diverticulitis who underwent colectomy. Patients were stratified into two groups based on preoperative hemoglobin levels, preop anemia and no-preop Anemia. Outcome measures were 30-day complications, anastomotic leaks, readmissions, mortality, and intra-/postoperative blood transfusion. We also performed a sub-analysis for patients who underwent emergent colectomy.

Results: Six thousand nine hundred sixty-three patients were included in the analysis, of which 37% (n = 2571) had preoperative anemia. Patients in the anemia group were more likely to have higher ASA class and receive blood 72-h preoperatively (5.4% vs. 0.2%, p < 0.01). Patients in the anemia group had higher rates of complications (35.4% vs. 24.7%, p < 0.01), unplanned readmission (9.2% vs 7.2%, p < 0.01), mortality (4.5% vs. 1.8%, p < 0.01), and intra/postoperative transfusion requirement (21% vs. 3.8%, p < 0.01) with no difference in rate of anastomotic leaks. On sub-analysis, 39% of the cases were completed in an emergent setting, 85% of which were due to perforation. Patients with preoperative anemia that underwent colectomy in an emergent setting had higher odds of intra/postoperative blood transfusion (OR 51.6, CI 3.87-6.87, p < 0.01) with no statistical significance in 30-day complications (p = 0.51).

Conclusion: Preoperative anemia in patients undergoing colectomy for acute diverticular disease is associated with higher odds complications, readmissions, and intra/postoperative blood transfusions.