Preoperative anemia and surgical outcomes following laparotomy in a resource-limited setting

Introduction: Anemia is a common and potentially modifiable condition in sub-Saharan Africa. We sought to determine the role of preoperative anemia on post laparotomy abdominal complications.

Methods: We 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.

Results: Of 280 patients, most were male (76.4%) with 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).

Conclusion: Anemia is a common but modifiable comorbidity among laparotomy patients and independently increases the risk of abdominal complications.