Correlations Between Neoadjuvant Treatment, Anemia, and Perioperative Complications in Patients Undergoing Esophagectomy for Cancer

Marcovalerio Melis, James Mcloughlin, E. Michelle Dean, Erin M. Siegel, Jill M. Weber, Nilay Shah, Scott T. Kelley, Richard C. Karl

Research output: Contribution to journalArticle

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Abstract

Introduction: The influence of preoperative hemoglobin levels on outcomes of patients undergoing esophagectomy for cancer is not clearly defined. The goal of this article was to explore the association between combined modality therapy, preoperative anemia status, and perioperative blood transfusion and risk of postoperative complications among patients undergoing esophageal resection. Methods: From a retrospective esophageal database, 413 patients were identified. Anemia was defined according to the World Health Organization classification of <13 g/dL or <12 g/dL for men or women, respectively. Statistical analysis was performed with analysis of variance, Pearson's χ2, or Fisher exact test as appropriate. The independent association of anemia, blood transfusion, and combined modality treatment on risk of postoperative complications were examined using multiple logistic regression. Results: Information on combined modality treatment, preoperative hemoglobin levels, and blood transfusion was available for 413 patients, of whom 57% received combined modality treatment. Overall 197 (47.6%) patients were preoperatively found to be anemic, and those who had received combined modality treatment were more likely to be anemic (60.6% versus 30.7%, P < 0.001). Anemic patients required more blood transfusions than nonanemic patients (46.7% versus 29.6%, P < 0.001). Seventy-five percent of patients who required transfusion during the hospital stay had received combined modality treatment (P = 0.01). Combined modality treatment and anemia were not associated with increased risk of complications. Patients with any perioperative complication and surgical site infections were more likely to have received blood transfusion compared to patients without complications (OR = 1.73; 95% CI 1.04-2.87 and OR = 2.98; 95% CI 1.04-8.55; respectively). Conclusions: Overall, we determined that administration of neoadjuvant treatment to esophageal cancer patients was not associated with an increased rate of perioperative complications. Preoperative anemia did not predict worsened short-term outcomes, but increased the chances of red blood cell transfusion, which were significantly associated with higher overall complications and increased risk of surgical site infections. These data confirm previous studies that allogenic red blood cell transfusions are independent risk factors for increased morbidity and mortality and should be minimized during surgery for esophageal cancer.

Original languageEnglish (US)
Pages (from-to)114-120
Number of pages7
JournalJournal of Surgical Research
Volume153
Issue number1
DOIs
StatePublished - May 1 2009

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Neoadjuvant Therapy
Esophagectomy
Anemia
Blood Transfusion
Neoplasms
Surgical Wound Infection
Erythrocyte Transfusion
Esophageal Neoplasms
Hemoglobins
Therapeutics
Combined Modality Therapy
Length of Stay
Analysis of Variance
Logistic Models
Databases
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Correlations Between Neoadjuvant Treatment, Anemia, and Perioperative Complications in Patients Undergoing Esophagectomy for Cancer. / Melis, Marcovalerio; Mcloughlin, James; Dean, E. Michelle; Siegel, Erin M.; Weber, Jill M.; Shah, Nilay; Kelley, Scott T.; Karl, Richard C.

In: Journal of Surgical Research, Vol. 153, No. 1, 01.05.2009, p. 114-120.

Research output: Contribution to journalArticle

Melis, Marcovalerio ; Mcloughlin, James ; Dean, E. Michelle ; Siegel, Erin M. ; Weber, Jill M. ; Shah, Nilay ; Kelley, Scott T. ; Karl, Richard C. / Correlations Between Neoadjuvant Treatment, Anemia, and Perioperative Complications in Patients Undergoing Esophagectomy for Cancer. In: Journal of Surgical Research. 2009 ; Vol. 153, No. 1. pp. 114-120.
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abstract = "Introduction: The influence of preoperative hemoglobin levels on outcomes of patients undergoing esophagectomy for cancer is not clearly defined. The goal of this article was to explore the association between combined modality therapy, preoperative anemia status, and perioperative blood transfusion and risk of postoperative complications among patients undergoing esophageal resection. Methods: From a retrospective esophageal database, 413 patients were identified. Anemia was defined according to the World Health Organization classification of <13 g/dL or <12 g/dL for men or women, respectively. Statistical analysis was performed with analysis of variance, Pearson's χ2, or Fisher exact test as appropriate. The independent association of anemia, blood transfusion, and combined modality treatment on risk of postoperative complications were examined using multiple logistic regression. Results: Information on combined modality treatment, preoperative hemoglobin levels, and blood transfusion was available for 413 patients, of whom 57{\%} received combined modality treatment. Overall 197 (47.6{\%}) patients were preoperatively found to be anemic, and those who had received combined modality treatment were more likely to be anemic (60.6{\%} versus 30.7{\%}, P < 0.001). Anemic patients required more blood transfusions than nonanemic patients (46.7{\%} versus 29.6{\%}, P < 0.001). Seventy-five percent of patients who required transfusion during the hospital stay had received combined modality treatment (P = 0.01). Combined modality treatment and anemia were not associated with increased risk of complications. Patients with any perioperative complication and surgical site infections were more likely to have received blood transfusion compared to patients without complications (OR = 1.73; 95{\%} CI 1.04-2.87 and OR = 2.98; 95{\%} CI 1.04-8.55; respectively). Conclusions: Overall, we determined that administration of neoadjuvant treatment to esophageal cancer patients was not associated with an increased rate of perioperative complications. Preoperative anemia did not predict worsened short-term outcomes, but increased the chances of red blood cell transfusion, which were significantly associated with higher overall complications and increased risk of surgical site infections. These data confirm previous studies that allogenic red blood cell transfusions are independent risk factors for increased morbidity and mortality and should be minimized during surgery for esophageal cancer.",
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T1 - Correlations Between Neoadjuvant Treatment, Anemia, and Perioperative Complications in Patients Undergoing Esophagectomy for Cancer

AU - Melis, Marcovalerio

AU - Mcloughlin, James

AU - Dean, E. Michelle

AU - Siegel, Erin M.

AU - Weber, Jill M.

AU - Shah, Nilay

AU - Kelley, Scott T.

AU - Karl, Richard C.

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N2 - Introduction: The influence of preoperative hemoglobin levels on outcomes of patients undergoing esophagectomy for cancer is not clearly defined. The goal of this article was to explore the association between combined modality therapy, preoperative anemia status, and perioperative blood transfusion and risk of postoperative complications among patients undergoing esophageal resection. Methods: From a retrospective esophageal database, 413 patients were identified. Anemia was defined according to the World Health Organization classification of <13 g/dL or <12 g/dL for men or women, respectively. Statistical analysis was performed with analysis of variance, Pearson's χ2, or Fisher exact test as appropriate. The independent association of anemia, blood transfusion, and combined modality treatment on risk of postoperative complications were examined using multiple logistic regression. Results: Information on combined modality treatment, preoperative hemoglobin levels, and blood transfusion was available for 413 patients, of whom 57% received combined modality treatment. Overall 197 (47.6%) patients were preoperatively found to be anemic, and those who had received combined modality treatment were more likely to be anemic (60.6% versus 30.7%, P < 0.001). Anemic patients required more blood transfusions than nonanemic patients (46.7% versus 29.6%, P < 0.001). Seventy-five percent of patients who required transfusion during the hospital stay had received combined modality treatment (P = 0.01). Combined modality treatment and anemia were not associated with increased risk of complications. Patients with any perioperative complication and surgical site infections were more likely to have received blood transfusion compared to patients without complications (OR = 1.73; 95% CI 1.04-2.87 and OR = 2.98; 95% CI 1.04-8.55; respectively). Conclusions: Overall, we determined that administration of neoadjuvant treatment to esophageal cancer patients was not associated with an increased rate of perioperative complications. Preoperative anemia did not predict worsened short-term outcomes, but increased the chances of red blood cell transfusion, which were significantly associated with higher overall complications and increased risk of surgical site infections. These data confirm previous studies that allogenic red blood cell transfusions are independent risk factors for increased morbidity and mortality and should be minimized during surgery for esophageal cancer.

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