Impact of anaemia at discharge following colorectal cancer surgery

Abstract

Objectives Preoperative anaemia is common in patients with colorectal cancer and increasingly optimised prior to surgery. Comparably little attention is given to the prevalence and consequences of postoperative anaemia. We aimed to investigate the frequency and short- or long-term impact of anaemia at discharge following colorectal cancer resection. Methods A dedicated, prospectively populated database of elective laparoscopic colorectal cancer procedures undertaken with curative intent within a fully implemented ERAS protocol was utilised. The primary endpoint was anaemia at time of discharge (haemoglobin (Hb) < 120 g/L for women and < 135 g/L for men). Patient demographics, tumour characteristics, operative details and postoperative outcomes were captured. Median follow-up was 61 months with overall survival calculated with the Kaplan-Meier log rank method and Cox proportional hazard regression based on anaemia at time of hospital discharge. Results A total of 532 patients with median 61-month follow-up were included. 46.4% were anaemic preoperatively (cohort mean Hb 129.4 g/L ± 18.7). Median surgical blood loss was 100 mL (IQR 0–200 mL). Upon discharge, most patients were anaemic (76.6%, Hb 116.3 g/L ± 14, mean 19 g/L ± 11 below lower limit of normal, p < 0.001). 16.7% experienced postoperative complications which were associated with lower discharge Hb (112 g/L ± 12 vs. 117 g/L ± 14, p = 0.001). Patients discharged anaemic had longer hospital stays (7 [5–11] vs. 6 [5–8], p = 0.037). Anaemia at discharge was independently associated with reduced overall survival (82% vs. 70%, p = 0.018; HR 1.6 (95% CI 1.04–2.5), p = 0.034). Conclusion Anaemia at time of discharge following elective laparoscopic colorectal cancer surgery and ERAS care is common with associated negative impacts upon short-term clinical outcomes and long-term overall survival.

Impact and outcomes of postoperative anaemia in colorectal cancer patients: a systematic review

“…This is consistent with the current practice of minimally invasive surgery and the wide use of advanced techniques of haemostasis during laparoscopic surgery [22]. Nevertheless, conversion to open surgery seems to be significantly associated with intra-operative blood loss, postoperative anaemia and its adverse impact on postoperative outcomes [17]. Additionally, prolonged hospitalization and postoperative complications are known risk factors for developing postoperative anaemia due to frequent blood sampling, inadequate nutritional intake and malabsorption, all of which may have potentially contributed [23].…”

“…The mechanistic causes of postoperative anaemia rates among colorectal cancer patients remain unclear in the literature. Dru et al [17] have explored this outcome in detail, as it was one of the primary outcomes of their study. Preoperative anaemia is still a common presentation of colorectal cancer and a significant proportion of patients may not have been optimally corrected prior to surgery.…”

“…One paper was a multicentre randomized clinical trial (RCT) from the UK [16], while the other five papers were retrospective cohort studies representing three European countries [11,12,[17][18][19]. Only one paper had postoperative anaemia as their primary end-point [17] while others reported on correction of anaemia and/or rate of blood cell transfusions as the primary end-points [11,[18][19][20].…”

“…The definition of postoperative anaemia varied across the studies, as some reported on anaemia at discharge while others stated anaemia at the immediate postoperative days in hospital. The prevalence of postoperative anaemia was reported in four studies as 62%, 76.6%, 82% and 87% [11,12,17,18].…”

“…The duration of follow-up was variable from 30 days to 61 months [17][18][19]21]. There was a significant improvement in QoL scores in 13 components of the QoL questionnaires in the correction of anaemia using the IVI group, in comparison to only one component in the oral group [21].…”