Impact of preoperative anemia on surgeries for pelvic floor disorders


      To determine the relationship between preoperative hematocrit (Hct) and 30-day perioperative complications in women undergoing pelvic organ prolapse (POP) procedures.

      Materials and Methods

      Using Current Procedural Terminology and International Classification of Diseases codes 9th and 10th edition, women undergoing POP repair between 2011-2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program Database. Subjects were classified based on Hct value ranges: severe anemia (<28.0), moderate anemia (28.0-31.9), mild anemia (32.0-35.9), normal Hct (36.0-44.0), elevated Hct (>44.0). Primary outcomes were overall morbidity, mortality, readmission, and return to operating room in the 30-day perioperative period. Secondary outcomes were rates of specific complications for each Hct classification with substratification by specific apical suspension procedure (sacrospinous ligament fixation, uterosacral ligament suspension, and sacrocolpopexy). Statistical significance was determined as p<0.05. Logistic regression was used to control for significant demographic comorbidities.


      Between 2011-2019, 101,238 subjects underwent POP procedures. After exclusions, 67,538 subjects were included for final analysis. The majority of patients were 65 years or older (38.7%), white (73.7%), and non-Hispanic (73.0%). The overall rate of anemia (Hct<36.0) was 10.2%. Severely anemic patients had the highest overall complication rates (29.1%), followed by moderate anemia (17.7%), mild anemia (10.2%), and normal Hct (8.4%). Degree of anemia was associated with increased rate of return to operating room, re-admission, and mortality. The relationship between complication rate and degree of anemia was present in all different apical suspension techniques. The association between degree of anemia and overall and all major complications remained statistically significant on multivariable logistic regression.


      Anemia is an independent risk factor for 30-day perioperative complications in POP surgery. Degree of anemia has a direct correlation to complication rates.
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