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Author Notes:

Soheir Adam, MD, Duke Comprehensive Sickle Cell Center, Duke University, Box 3939, Durham, NC 27710. soheir.adam@duke.edu.

Subjects:

Research Funding:

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:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Medicine, General & Internal
  • General & Internal Medicine
  • cholecystectomy
  • pregnancy
  • pregnancy complications
  • sickle cell disease
  • surgery
  • SERUM BILIRUBIN LEVELS
  • BODY-MASS INDEXES
  • PREOPERATIVE TRANSFUSION
  • ALPHA-THALASSEMIA
  • JOINT REPLACEMENT
  • SURGERY
  • ANEMIA
  • HIP
  • EXPERIENCE
  • CHOLECYSTECTOMY

Surgical and obstetric outcomes in adults with sickle cell disease

Tools:

Journal Title:

American Journal of Medicine

Volume:

Volume 121, Number 10

Publisher:

, Pages 916-921

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2008 Elsevier Inc. All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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