Do Preoperative Labs Matter? Anemia and Complications After Prolapse Surgery

Objectives: Preoperative anemia is an independent risk factor for perioperative complications, however few studies have examined the impact of preoperative anemia on adverse events after prolapse surgery. We sought to examine the association between preoperative hemoglobin concentration and perioperative complications within 8 weeks of pelvic organ prolapse (POP) surgery. We hypothesized that preoperative anemia would be associated with greater perioperative complications.

Methods: We performed a secondary analysis of a dual-center retrospective study examining perioperative complications in biologic females aged ≥61 years who underwent prolapse surgery from January 2016 to May 2023. Preoperative anemia was defined as hemoglobin level < 12.0g/dL within two months preceding POP surgery. For comparison, we created a matched cohort of non-anemic women using 1:3 matching by age and surgical approach. The primary outcome was 8-week perioperative complications, which we defined as a composite including any one of the following adverse events: intraoperative complications (conversion to open, bladder, ureteral, bowel injury, or estimated blood loss ≥500), postoperative adverse events including transfusion, reoperation, readmission, emergency room evaluation, discharge to skilled nursing facility, cardiac complication, venous thromboembolism, hematoma, wound dehiscence, ileus/small bowel obstruction, surgical site infection, urinary tract infection (UTI), and other complications. Clinical and demographic variables were analyzed using chi-square (Fisher’s exact) and t-test (Mann-Whitney U) as appropriate. Multivariable logistic regression (LR) including all relevant variables with p< 0.05 on univariate LR was performed

Results: Our study cohort included 960 women: 230 with preoperative anemia and 690 without preoperative anemia. Most patients were White (96%), and the mean age was 74±7 years. Patients with preoperative anemia had a higher body mass index (BMI) (27.9±5.7 kg/m2 vs 27.1±4.4 kg/m2, p=0.03) and Charlson Comorbidity Index (CCI) score (median (interquartile range) 4 (3-5) vs 3 (3-4), p = 0.01) (Table 1). They were also more likely to undergo apical native tissue procedures (p=0.004), colpectomy (p=0.003), concomitant hysterectomy (p=0.01), and have shorter surgical duration (p =0.03).
There was no difference in 8-week perioperative complications between groups (OR 1.30, 95% CI [0.93-1.82] (Table 2). Anemic patients had a 59% greater odds of postoperative UTI (95% CI [1.03- 2.46]) on univariate analysis. This association remained significant on multivariable LR controlling for race, concomitant hysterectomy, colpectomy, CCI score, and BMI (aOR 1.68, 95% CI [1.06-2.65]).

Conclusions: Preoperative anemia was associated with nearly 70% greater odds of postoperative UTI, but not with other perioperative complications. Larger studies are needed to confirm these results and examine the impact of anemia severity on perioperative outcomes.