Exploring red cell distribution width as a potential risk factor in emergency bowel surgery-A retrospective cohort...

Area of Science:

• Medical Research
• Clinical Pathology
• Surgical Outcomes

Background:

• Elevated preoperative red cell distribution width (RDW) is linked to mortality in older patients undergoing non-cardiac surgery.
• The association between RDW and mortality in adult emergency laparotomy patients, including 30-day and long-term outcomes, is not well-established.
• The prognostic value of anisocytosis and its relationship with frailty in this patient cohort require further investigation.

Purpose of the Study:

• To examine the relationship between increased RDW and postoperative mortality in adult emergency laparotomy patients.
• To investigate the prognostic significance of anisocytosis (variation in red blood cell size).
• To explore the association between elevated RDW and frailty in this patient population.

Main Methods:

• Retrospective analysis of the National Emergency Laparotomy Audit (NELA) database from St Mary's Hospital (January 2014 - April 2018).
• Inclusion of 356 adult patients undergoing emergency laparotomy.
• Application of Cox regression for survival analysis and multivariable logistic regression for RDW and frailty, with internal validation via bootstrap resampling.

Main Results:

• A total of 33 (9.3%) 30-day deaths and 72 (20.2%) overall deaths were recorded.
• Higher median RDW values were observed in non-survivors compared to survivors at both 30 days (14.9% vs 13.8%, p=0.007) and overall (14.9% vs 13.7%, p<0.001).
• Increasing RDW quartiles correlated with increased mortality and frailty. Elevated RDW was associated with a higher likelihood of frailty for both 30-day (OR 4.3) and overall mortality (OR 4.9). Anisocytosis was linked to overall death rates.

Conclusions:

• Preoperative anisocytosis, indicated by increased RDW, is associated with greater long-term mortality following emergency laparotomy.
• Increasing RDW demonstrates a significant relationship with patient frailty.
• RDW is a readily available and cost-effective marker that warrants prospective validation in larger cohorts for its prognostic role in emergency laparotomy.