Surgical and obstetric outcomes in adults with sickle cell disease

• Type of Material: Article
• Authors: Soheir Adam, Duke University; Jude Jonassaint, Duke University; Hillary Kruger, Duke University; Melanie Kail, Duke University; Eugene P. Orringer, University of North Carolina; James R Eckman, Emory University; Allison Ashley-Koch, Duke University; Marilyn J. Telen, Duke University; Laura M. De Castro, Duke University
• Language: English
• Date: 2008-10-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2008 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjmed.2008.04.040
• Title of Journal or Parent Work: American Journal of Medicine
• ISSN: 0002-9343
• Volume: 121
• Issue: 10
• Start Page: 916
• End Page: 921
• Grant/Funding Information: This work was supported by grants R01 HL68959 and U10 HL083698 from the National Heart, Lung and Blood Institute, National Institutes of Health (NIH).; LDC is the Sickle Cell Scholar for the Duke-UNC Comprehensive Sickle Cell Center (HL070769).
• Keywords: BODY-MASS INDEXES; Life Sciences & Biomedicine; EXPERIENCE; sickle cell disease; SURGERY; ANEMIA; surgery; PREOPERATIVE TRANSFUSION; Medicine, General & Internal; Science & Technology; pregnancy complications; SERUM BILIRUBIN LEVELS; JOINT REPLACEMENT; General & Internal Medicine; pregnancy; ALPHA-THALASSEMIA; cholecystectomy; HIP; CHOLECYSTECTOMY
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Obstetrics and Gynecology

Abstract

Background: Sickle cell disease patients are more likely than the general population to undergo surgery and usually do so at a younger age. Female sickle cell disease patients also have special gynecological and obstetric issues related to their disease. Methods: We collected data through standardized clinical report forms, patient interviews, and medical records from 509 adult sickle cell disease patients. Logistic regression was used to estimate the association between multiple variables and each of the surgery types. We also determined the prevalence and outcomes of pregnancy in 284 women with sickle cell disease in this population. Results: Almost 50% of patients aged 18-27 years had had a cholecystectomy. Mean corpuscular hemoglobin, total bilirubin, and lactate dehydrogenase were significantly higher in the postcholecystectomy group; 9.5% of 504 individuals had undergone splenectomy. Hematocrit, body mass index, and red blood cell count were significantly higher in the postsplenectomy group. Hip replacement had been performed in 9.2% of individuals, with the prevalence increasing as early as the fourth decade and continuing to increase through the sixth decade of life. A history of pregnancy was present in 190 women (67%). Of 410 pregnancies, only 53.9% resulted in live births, 16.6% were voluntarily terminated, and 29.5% were complicated by miscarriage, still birth, or ectopic implantation. Conclusions: Sickle cell disease continues to have a strong effect on the mean age for common surgeries and impacts pregnancy outcomes. We conclude that this population has a unique surgical and obstetric history that should be further studied to provide insight into potentially more effective preventive approaches to end-organ damage.