(Poster 129) Preoperative Anemia as a Predictor of Perioperative Complications

Objectives: To determine the association between preoperative anemia and perioperative complications in patients undergoing anterior colporrhaphy, utilizing the standardized Clavien-Dindo classification system for comprehensive complication assessment

Methods: This retrospective cohort study analyzed 231 women who underwent anterior colporrhaphy at Soroka University Medical Center between 2014 and 2023. Patients were stratified by preoperative hemoglobin levels, with anemia defined as hemoglobin < 11 g/dL. Demographic, clinical, obstetrical, and operative characteristics were compared between anemic and non-anemic groups. Perioperative complications were systematically documented during a 12-month follow-up period using Clavien-Dindo classification system. Univariate analysis identified variables associated with complications (P < 0.2), which were subsequently included in multivariate logistic regression modeling to control potential confounders.

Results: During the 12-month follow-up period, 48% of participants experienced at least one perioperative complication, with minor complications (Clavien-Dindo grades 1-2) predominating. A significant association was observed between preoperative anemia and complication rates; 90% of women with hemoglobin levels < 11 mg/dL experienced at least one complication compared to 46% of non-anemic women (p=0.006). Preoperative anemia showed a significant association with diabetes (p < 0.001), while no significant associations were found with advanced age, grand multiparity (>5 births), obesity (BMI >30), or substantial intraoperative blood loss (>2 g/dL). After adjusting for confounders including age and diabetes in multivariate analysis, preoperative anemia remained an independent risk factor for perioperative complications (adjusted hazard ratio=10.33, 95% CI 1.251-85.32, p=0.03).

Conclusions: Preoperative anemia independently confers a ten-fold increased risk for perioperative complications following anterior colporrhaphy. These findings highlight the importance of preoperative hemoglobin optimization as a potentially modifiable risk factor that could significantly reduce complication rates in women undergoing pelvic reconstructive surgery.

Figure. Prevalence of Perioperative Complications According to Hemoglobin Levels, Based on the Clavien-Dindo Classification System. (a) Highest complication grade recorded during the 12-month follow-up period (p = 0.002). (b) Total number of complications recorded during the 12-month follow-up period (p = 0.004).