Relatively there is a high occurrence of anemia in sub-Saharan Africa due to a high regional prevalence of malnutrition, malaria, and chronic infections. The role of preoperative anemia on post laparotomy abdominal complications is very significant. The study states that an estimated 77.2 million disability-adjusted life-years (DALYs) could be averted by life-saving surgical care. The study was carried out by John Sincavage and team in Malawi. The study has been published in The American Journal of Surgery.
The objective of the study was to determine the role of preoperative anemia on post laparotomy abdominal complications. On a cohort of laparotomy patients, the presence of moderate or severe preoperative anemia in comparison to the relative risk of abdominal complications compared to mild or no preoperative anemia was evaluated.
Researchers conducted a six-month prospective, observational study of patients age >12 years Following laparotomy at a tertiary hospital in Malawi. The outcome was the occurrence of abdominal complications. Poisson regression analyses estimated the risk of abdominal complications in patients with moderate/severe anemia.
The researchers found out that of 280 patients, most were male (76.4%) with a median age of 35 years (IQR 24-50). Abdominal complications developed in 34 patients (15.2%). Of the 224 patients with known preoperative hemoglobin 54 (20.7%) were moderately or severely anemic at the time of surgery. Patients with moderate-to-severe anemia had an increased risk of abdominal complications (RR 4.44, 95% CI 2.0-9.6).
The researchers concluded that "Anemia is a common but modifiable comorbidity among laparotomy patients and independently increases the risk of abdominal complications." Rapid preoperative identification of moderate or severe anemia may identify patients who would benefit from increased postoperative surveillance. Efforts to modify anemia as a risk factor before surgery are essential, particularly in resource-limited settings.
For further information:
John Sincavage, Brittany Robinson, Vanessa J. Msosa, Chawezi Katete, Laura N. Purcell, Anthony Charles "Preoperative anemia and surgical outcomes following laparotomy in a resource-limited setting" The American Journal of Surgery 222 (2021) 424-430.