Abstract

NM-200

Complications associated with anemia in neonatal surgery

Syed F, Miller R, walia H, Tumin D, McKee C, Tobias J
Nationwide Children's Hospital, Columbus, OH, United states

INTRODUCTION: Anemia serves as an indicator of overall health and may signify various underlying conditions such as nutritional deficiencies, excessive blood loss, and malignancies. In children age >1 year old undergoing surgery, pre-operative anemia has been associated with greater risk of in-hospital mortality. We used a national registry to explore the association between anemia and postoperative complications in patients age <1 year undergoing pyloromyotomy, a common neonatal surgery.
METHODS: Patients age <1 year undergoing pyloromyotomy in 2013-2015 were identified in the National Surgical Quality Improvement Program-Pediatric registry. Using previous population-based data, we defined preoperative anemia in term (≥37 weeks gestation) infants age ≥4 weeks up to 1 year as hematocrit (Hct) ≤30%. We excluded patients <4 weeks of age, patients born prematurely, and patients receiving perioperative blood transfusions. The primary outcome was any surgical complication, including wound complications, surgical site infections (SSIs), cardiac arrest, reintubation, urinary tract infection, pneumonia, renal failure, neurological complications, reoperation, unplanned readmission, hospital stay >30 days, and 30 day mortality. We also examined wound complications (including SSIs) alone. Complication rates were compared by anemia status using Chi-square or Fisher’s exact tests.
RESULTS: The database included 1,832 patients age 4 weeks to 1 year who underwent pyloromyotomy and had preoperative Hct recorded (1,494/338 male/female; age 46±21 days; weight 4±1 kg; Hct 35±5%, obtained 1±3 days before surgery). 297 patients were anemic. On bivariate analysis, the complication rate did not differ between anemic (5%) and non-anemic (5%) patients (Table; p=0.883). The rate of wound complications was 1% (n=24) and did not differ by anemia status on bivariate analysis (p=0.408).
DISCUSSION: Anemia is a symptom of several conditions and may predict postoperative complications. In previous studies, preoperative anemia was associated with increased risk of in-hospital mortality in children ages >1 year, and perioperative blood transfusion was associated with increased risk of wound complications. However, our analysis of a common neonatal surgery suggests that, in children <1 year of age undergoing pyloromyotomy, preoperative anemia is not associated with surgical complications. This finding may be related to the transitory nature of anemia in neonates, or to age-based differences in the definition of anemia. The null association between anemia and surgical complications in this cohort raises the question of whether an age threshold exists below which preoperative anemia may not influence outcomes of common pediatric surgeries.
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