Background: Postoperative anaemia is associated with increased postoperative morbidity. The optimal timing for postoperative packed cell volume (PCV) assessment remains unclear and varies across surgical units.
Objective:This study compared PCV values on postoperative days 1 and 2 to determine their relationship with the expected postoperative PCV.
Method: A cross-sectional study was conducted among patients who had elective gynaecological surgeries at a tertiary Hospital in Southern Nigeria. PCV was measured preoperatively and at 24 and 48 hours postoperatively. Data on intraoperative blood loss, type of surgery, and anaesthesia were recorded.
Results: The mean PCV on postoperative day 1 was 30.87 ± 3.85%, while on day 2, it was 30.33 ± 3.70%, with a significant difference (p = 0.005). The expected postoperative PCV was 31.02 ± 2.68%. The difference between day 1 PCV and the expected PCV was not statistically significant (p = 0.682). Similarly, the day 2 PCV was not significantly different from the expected value (p = 0.064).
Conclusion: Although a significant decline in PCV occurred between postoperative days 1 and 2, the day 1 PCV was closer to the expected postoperative value. This suggests that day 1 may be a more reliable time for routine PCV monitoring after gynaecological surgeries.
Keywords: Packed cell volume, Postoperative, Gynaecology, Timing, Haematocrit
INTRODUCTION
Anaemia affects 1.6 billion people worldwide,1 with higher prevalence in low and middle-income countries.2 About 313 million surgeries are carried out worldwide each year,3 and postoperative anaemia complicates 80- 90% of major surgeries.4 The red cell mass of females is reduced compared to males but has comparable amounts of blood loss when undergoing a similar procedure. One-third of all non-pregnant women are anaemic, and about 96% of women have a drop in packed cell volume postoperatively.1,5,6 Thus, they generally have a higher transfusion rate compared to men.7
The cause of postoperative anaemia is multifactorial, including preoperative anaemia, intraoperative blood loss, increased duration of operation, coagulopathy and nutritional deficiencies.5,6,8 Preoperative anaemia, which is seen in 50% of patients undergoing surgery, can be an independent cause of postoperative anaemia and has been associated with poor surgical= outcomes.9,10 Intraoperative excessive fluid administration can cause dilutional anaemia or worsen pre-existing anaemia.11,12 The completion of surgery does not imply an end to blood loss. Postoperative blood loss can continue through surgical drains or in the form of reactionary haemorrhage.13,14 Additionally, smaller body surface area, older age and the presence of some co- morbidities were implicated in its aetiology.6,15
Surgery exposes patients to both intraoperative and postoperative stressors. The worries concerning anaemia are related to its negative influence on recovery, rehabilitation, hospital readmission or re-operation, patient well-being, and healthcare costs.17 Anaemia in the postoperative period is associated with increased morbidity, 90-day and 30-day mortality.17,18 It also predisposes to poor wound healing, increased risk of wound breakdown and sepsis, early postoperative myocardial minfarction.19–21 Generally, all categories of anaemia are associated with a prolonged hospital stay, which is worsened by co-morbidities. A unit of red cell transfusion raises an average adult’s haemoglobin by approximately 1 g/dL and increases the packed cell volume by about 3%. Similarly, a blood loss of 500 mL results in a 3% decrease in packed cell volume.22,23
These complications rationalise the need to identify patients with anaemia in the immediate postoperative period for early intervention. Aside from postoperative packed cell volume, quantification of surgical blood loss can be a good pointer to assess the likelihood of postoperative anaemia. Delayed diagnosis of anaemia can lead to delayed intervention and prolonged hospital stay in a world where early hospital discharge is advocated.21,24
There is a paucity of medical literature about the best timing of postoperative packed cell volume following gynaecological surgeries. The existing studies primarily focused on orthopaedic patients, whereas those involving obstetrics and gynaecology were mainly on obstetric patients.
This study aimed to assess if a difference exists between day one and day two packed cell volume. This ultimately will help determine the optimal timing of postoperative packed cell volume estimation following gynaecological surgeries.