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Surgery and anesthesia in sickle cell disease. Cooperative Study of Sickle
Cell Diseases
M Koshy, SJ Weiner, ST Miller, LA Sleeper, E Vichinsky, AK Brown, Y Khakoo and TR Kinney
University of Illinois, Chicago 60612, USA.
From 1978 to 1988, The Cooperative Study of Sickle Cell Disease observed
3,765 patients with a mean follow-up of 5.3 +/- 2.0 years. One thousand
seventy-nine surgical procedures were conducted on 717 patients (77% sickle
cell anemia [SS], 14% sickle hemoglobin C disease [SC], 5.7% S beta zero
thalassemia, 3% S beta zero + thalassemia). Sixty-nine percent had a single
procedure, 21% had two procedures, and the remaining 11% had more than two
procedures during the study follow- up. The most frequent procedure was
abdominal surgery for cholecystectomy or splenectomy (24% of all surgical
procedures, N = 258). Of these, 93% received blood transfusion, and there
was no association between preoperative hemoglobin A level and complication
rates (except reduction in pain crisis). Overall mortality within 30 days
of a surgical procedure was 1.1% (12 deaths after 1,079 surgical
procedures). Three deaths were considered to be related to the surgical
procedure and/or anesthesia (0.3%). No deaths were reported in patients
younger than 14 years of age. Sickle cell diseases (SCD)-related
complications after surgery were more frequent in SS patients who received
regional compared with general anesthesia (adjusted for risk level of the
surgical procedure, patient age, and preoperative transfusion status, P =
.058). Non-SCD-related postoperative complications were higher in both SS
and SC patients who received regional compared with those who received
general anesthesia (P =.095). Perioperative transfusion was associated with
a lower rate of SCD- related postoperative complications for SS patients
undergoing low-risk procedures (P = .006, adjusted for age and type of
anesthesia), with crude rated of 12.9% without transfusion compared with
4.8% with transfusion. In SC patients, preoperative transfusion was
beneficial for all surgical risk levels (P = .009). Thus, surgical
procedures can be performed safely in patients with SCD.
Volume 86,
Issue 10,
pp. 3676-3684,
11/15/1995
Copyright © 1995 by The American Society of Hematology
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