title: Preoperative anemia is associated with increased use of hospital resources in patients undergoing elective hepatectomy.
abstract: BACKGROUND
  In patients undergoing elective hepatectomy, we aimed to evaluate the effect of preoperative anemia on postoperative mortality, morbidity, readmission, risk of blood transfusion, and duration of hospital stay.
  
  
  METHODS
  A total of 4,170 patients who underwent elective hepatectomy from 2010 to 2012 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Univariate and multivariate analyses were performed by examination of the association of preoperative anemia (defined as hematocrit <5) and the risk of any perioperative blood transfusion (defined as ≥1 unit of blood within 72 hours of operation), mean duration of stay, prolonged duration of stay (defined as ≥9 days, which represented the 75th percentile of this cohort), 30-day readmission, major morbidity, and mortality.
  
  
  RESULTS
  A total of 948 patients had preoperative anemia (22.7%). Preoperative anemia was associated with increased risk of any perioperative blood transfusion, prolonged duration of stay, major postoperative complication, and 30-day mortality (P < .05 for all analyses). After controlling for potentially confounding covariates, there was nearly a 3-fold greater risk of blood transfusion (adjusted OR = 2.79, P < .001) and 2-fold greater risk of prolonged duration of stay in anemic versus nonanemic patients (adjusted OR = 1.66, P < .001). Mean duration of stay was 10.0 days and 7.4 days for anemic and nonanemic patients, respectively (P < .001).
  
  
  CONCLUSIONS
  Anemia is associated with an almost 3-fold increased risk of blood transfusion, 2-fold increased risk of prolonged duration of hospitalization, and hospital stays were 2.6 days greater in anemic patients. Anemia may significantly impact resource utilization for elective hepatectomy.
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN.
authors.forename: May C
authors.initials: MC
authors.lastname: Tee
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Shubert
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ubl
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN. Electronic address: Nagorney.David@mayo.edu.
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Florencia G
authors.initials: FG
authors.lastname: Que
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D057234:Preoperative Period; D012307:Risk Factors