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Effects Of Preoperative Hemoglobin Level On Perioperative Outcomes And Overall Survival After Robotic-assisted Pulmonary Lobectomy
Sunny Kahlon1, Carla C. Moodie
2, Joseph R. Garrett
2, Katherine M. Dillen
2, Jenna R. Tew
2, Jobelle Joyce-Anne R. Baldonado
2, Jacques P. Fontaine
2, Eric M. Toloza
2;
1University of South Florida Health Morsani College of Medicine, Tampa, FL, USA,
2Moffitt Cancer Center, Tampa, FL, USA
BACKGROUND: Low preoperative hemoglobin has been associated with adverse surgical outcomes. We conducted an investigation to determine the effects of preoperative hemoglobin on perioperative outcomes and survival following robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy.
METHODS: We retrospectively analyzed 725 consecutive patients who underwent RAVT pulmonary lobectomy over 11.8 years. Based on preoperative hemoglobin, patients were grouped as Anemic (hemoglobin <12 g/dl for women and hemoglobin <13 g/dl for men) versus Non-Anemic (hemoglobin ≥12 g/dl for women and hemoglobin ≥13 g/dl for men). Statistically significant (p≤0.05) differences between the groups were determined by Chi-square/Fisher’s exact analysis, Student’s t test, Mann-Whitney U test, and Kaplan-Meier analysis.
RESULTS: There were 141 patients in the Anemic group and 584 patients in the Non-Anemic group. Anemic patients had greater incidences of preoperative weight loss than Non-Anemic patients (p<0.001). Patients in the Anemic group had greater estimated blood loss (p<0.001), skin-to-skin operative times (p=0.020), and hospital length of stay (p=0.021) than Non-Anemic patients. There was no significant difference in postoperative complication rates between the two groups. Overall conversion rate to thoracotomy was 9.2% (13/141) in Anemic patients versus 4.3% (24/584) in Non-Anemic patients (p=0.013). Anemic patients had greater incidences of intraoperative tracheobronchial injury than patients without anemia (p=0.030). Median overall survival was 50.4 months for the Anemic group versus 92.6 months for the Non-Anemic group (p<0.001).
CONCLUSIONS: Anemic patients had greater estimated blood loss, longer skin-to-skin operative times, longer hospital length of stay, and worse overall survival. However, Anemic patients did not have greater postoperative complication rates than Non-Anemic patients. Preoperative hemoglobin levels should be assessed to estimate the risks of RAVT lobectomy and help improve perioperative outcomes.
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