Management of PErioperative Anemia in EmeRgency Laparotomy Patients (PEARL Study)

There has been a drive on improving outcomes after Emergency Laparotomy (EmLap) due to the National Emergency Laparotomy Audit (NELA). This has focused mainly on preoperative and intraoperative management with less emphasis on other perioperative aspects. We aimed to assess the prevalence of anemia in EmLap patients and its management in a perioperative period, exploring the gaps in anemia care.

A retrospective cohort study of prospectively maintained database of 1055 EmLap patients (2016-2019) from a UK tertiary center was performed. Data were extracted from the NELA database, POLO study, electronic records (Welsh Clinical Portal). Statistics were performed in SPSS v27.

Among 740 patients, 77% underwent open surgery, with mean age of 61.9 years (range 18-98), median age of 65 years, and roughly equal sex distribution (female 54%). The median preoperative NELA risk was 3.6% (IQR 1.1-9.8). Over a quarter of patients (28.6%) were anemic on admission. Anemic patients had significantly longer hospital stays (median 12 days; >/ = 11 days, p = 0.008) and higher stoma formation rates (54.1% moderate anemia vs. 34.3% nonanemic; p = 0.002). Three-quarters of patients (74.2%) were anemic at discharge (median Hb: 108 g/L, range: 74-129 g/L) but only 12% were treated with oral or IV iron or blood transfusion; only 10% had anemia reported in their discharge letters with appropriate follow-up and management plan.

Anemia in patients undergoing emergency laparotomy is significantly under-recognized and inadequately managed at discharge, despite recognized increased morbidity. A structured pathway for continuing anemia treatment and discharge planning is urgently needed to improve outcomes.