title: Cholecystectomy in sickle cell anemia patients: perioperative outcome of 364 cases from the National Preoperative Transfusion Study. Preoperative Transfusion in Sickle Cell Disease Study Group.
abstract: Cholecystectomy is the most common surgical procedure performed in sickle cell anemia (SCA) patients. We investigated the effects of transfusion and surgical method on perioperative outcome. A total of 364 patients underwent cholecystectomy: group 1 (randomized to aggressive transfusion) 110 patients; group 2 (randomized to conservative transfusion) 120 patients; group 3 (nonrandomized nontransfusion) 37 patients; and group 4 (nonrandomized transfusion) 97 patients. Patients were similar except group 3 patients were more likely to be female, over 20 years old, smokers, and more healthy by American Society of Anesthesiologists (ASA) physical status score. Total complication rate was 39%: sickle cell events 19%; intraoperative or recovery room events 11%; transfusion complications 10%; postoperative surgical events 4%; and death 1%. Group 3 patients had the highest incidence of sickle cell events (32%). Open cholecystectomies were performed in 58% and laparoscopic in 42%. Laparoscopic patients were younger and more healthy by ASA score. Laparoscopic patients had longer anesthesia time (3.2 v 2.9 hours), but shorter hospitalization time (6.4 days v 9.8). Complications were similar between these two groups. We conclude that SCA patients undergoing cholecystectomy have a high perioperative morbidity, and the incidence of sickle cell events may be higher in patients not preoperatively transfused. We recommend a conservative preoperative transfusion regimen, and we encourage the use of the laparoscopic technique for SCA patients undergoing elective cholecystectomy.
authors.affiliation: Department of Anesthesiology, University of Washington, Seattle, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Haberkern
authors.forename: L D
authors.initials: LD
authors.lastname: Neumayr
authors.forename: E P
authors.initials: EP
authors.lastname: Orringer
authors.forename: A N
authors.initials: AN
authors.lastname: Earles
authors.forename: S M
authors.initials: SM
authors.lastname: Robertson
authors.forename: D
authors.initials: D
authors.lastname: Black
authors.forename: M R
authors.initials: MR
authors.lastname: Abboud
authors.forename: M
authors.initials: M
authors.lastname: Koshy
authors.forename: O
authors.initials: O
authors.lastname: Idowu
authors.forename: E P
authors.initials: EP
authors.lastname: Vichinsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000601:surgery*; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome