title: Impact of anemia on surgical outcomes: innovative interventions in resource-poor settings.
abstract: BACKGROUND
  The aim of this work was to study the impact of anemia on surgical outcomes and the impact of instituting appropriate workup and treatment of anemia on surgical outcomes.
  
  
  METHODS
  We conducted a case-control retrospective chart review of all hernia repair, hydrocele repair, and hysterectomy cases at the SEARCH Hospital in Gadchiroli, India, from January 2008 to April 2010, and included 340 male and 112 female surgical patients. We also performed a prospective assessment of the impact of the institution of appropriate workup and treatment of anemia on the surgical outcomes for all hernia repair, hydrocele repair, and hysterectomy cases at SEARCH from May 2010 to May 2011 and included 138 male and 76 female surgical patients.
  
  
  RESULTS
  The retrospective arm of the study included 340 males and 112 females with a median age of 39 and 41 years, respectively. The mean hemoglobin values were 12.50 (range = 8.8-15.4) for men and 10.39 (range = 5.2-14.8) for women. Patients with anemia had (1) increased incidence of spinal headache after inguinal hernia repair (p = 0.0266) and (2) increased incidence of fever after total hysterectomy (p = 0.0070). There was no statistically significant correlation between anemia and other outcomes (all p > 0.05). The prospective arm of the study included 138 males and 76 females with a median age of 35 and 40, respectively. The mean hemoglobin values were 11.8 (range = 6.4-14.8) for men and 10.6 (range = 6.9-12.8) for women. There was no statistically significant correlation between anemia and any surgical outcomes (p > 0.05). The incidence of complications in both the retrospective and the prospective arm was compared according to increasing severity of anemia across genders. Overall, there was no statistically significant increase in complication rates with increasing severity of anemia (p > 0.05).
  
  
  CONCLUSIONS
  In the retrospective arm of this study, anemia was associated with increased incidence of spinal headache and fever. In the prospective arm of this study, there was no statistically significant correlation between anemia and any surgical outcome. The incidence of complications did not increase with the severity of anemia in either arm of the study. Further investigation is needed into the optimal management and treatment of anemia prior to surgery in resource-poor settings.
authors.affiliation: Duke University School of Medicine, Durham, NC, USA. janaka.lagoo@gmail.com
authors.forename: Janaka
authors.initials: J
authors.lastname: Lagoo
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wilkinson
authors.forename: Julie
authors.initials: J
authors.lastname: Thacker
authors.forename: Mahesh
authors.initials: M
authors.lastname: Deshmukh
authors.forename: Sunanandha
authors.initials: S
authors.lastname: Khorgade
authors.forename: Rani
authors.initials: R
authors.lastname: Bang
mesh_terms: D000328:Adult; D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016022:Case-Control Studies; D015897:Comorbidity; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D006261:Headache / Q000453:epidemiology / Q000209:etiology; D059685:Herniorrhaphy / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D015994:Incidence; D007194:India; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D006848:Testicular Hydrocele / Q000601:surgery; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*