Early detection and correction of preoperative anemia in patients undergoing colorectal surgery – a prospective study

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Bootsma, Daitlin E. Huisman, Geert Kazemier, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5331736/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Apr, 2025 Read the published version in Techniques in Coloproctology → Version 1 posted 7 You are reading this latest preprint version Abstract Introduction Preoperative anemia is an important target in preventing colorectal anastomotic leakage (CAL). However, it is not consistently detected and corrected in patients undergoing colorectal surgery. This study aimed to evaluate the impact of early detection and correction of preoperative anemia on perioperative outcomes and CAL. Methods This was a prospective sub-analysis of the DoubleCheck study, an international open-labelled trial which implemented an enhanced care bundle to prevent CAL after elective colorectal surgeries. It introduced interventions for early detection and correction of preoperative anemia. Primary outcome was the incidence of preoperative anemia and the effect of early correction. Secondary outcomes included the impact on CAL, postoperative course, and mortality. Results The study included 899 patients across eight European hospitals (September 2021 - December 2023). Preoperative anemia was identified in 35.0% (n = 315) of participants, with 77.4% (n = 192) receiving iron therapy. Hemoglobin levels decreased in 4.2% (n = 13), remained stable in 45.8% (n = 143), and increased in 50.0% (n = 156) (p < 0.001). Perioperative hyperglycemia was more common among anemic patients (7.8% vs. 16.4%, p < 0.001). CAL occurred in 6.1% (n = 53) of the patients. Anemia correction and changes in hemoglobin levels after iron treatment were not significantly associated with CAL, other complications, or mortality. Conclusion The study demonstrated that anemia indicates overall poor physiological fitness rather than being an isolated risk factor. Early detection and correction of preoperative anemia is achievable and improves quality of care for elective colorectal surgery patients. Trial number NCT05250882 (20-01-2022) anemia iron transfusion colorectal surgery anastomotic leakage Introduction Colorectal anastomotic leakage (CAL) is one of the most severe complications, occurring in 2–19% of patients undergoing colorectal surgery [ 1 ]. Given that CAL can lead to abdominal sepsis, the necessity for stoma formation, increased mortality and heightened hospital costs, various strategies have been proposed to prevent this dreadful complication [ 2 , 3 ]. Recently, the focus has shifted towards identifying modifiable risk factors for CAL to develop the most effective preventive strategies [ 4 ]. Perioperative anemia has been identified as the most significant modifiable risk factor for CAL in a large international trial (OR 5.4, p < 0.001) [ 5 ]. Although some studies have reported conflicting results, the majority have demonstrated a significant association between preoperative anemia and the incidence of CAL [ 6 , 7 ]. The prevalence of preoperative anemia varies between 22% and 67%, depending on the specific definition of anemia and the hemoglobin cut-off values used [ 8 , 9 ]. Anemia is particularly prevalent in colorectal cancer patients, with an increased incidence of 40–80%, primarily due to intraluminal blood loss from the tumor site [ 10 ]. Preoperative anemia is predominantly caused by iron deficiency, which arises from impaired iron absorption, reduced iron availability, nutrient deficiencies, and occult intraluminal blood loss [ 11 ]. This leads to a reduced production of hemoglobin. The shortage of circulating hemoglobin impairs perfusion and oxygenation at the newly constructed anastomosis, both of which are critical for tissue healing, thereby increasing the risk of CAL [ 12 ]. Despite evidence indicating that preoperative anemia is a significant predictor of CAL and an important target for optimization, it is not consistently detected and corrected during the preoperative phase. Furthermore, a standardized care pathway for optimizing preoperative anemia in patients undergoing colorectal surgery is not available. The recent DoubleCheck study was the first to implement an enhanced care bundle, which consisted of early detection and correction of preoperative anemia, among other interventions [ 13 ]. The aim of this study was to obtain detailed information on the impact of early detection and correction of preoperative anemia on perioperative and postoperative outcomes in patients undergoing colorectal surgery. Methods Study design This open-labelled interventional study was conducted between September 2021 and December 2023 across eight European hospitals. It was designed as a prospective sub-analysis of the DoubleCheck study [ 13 ]. Ethical approval was obtained from the Ethical Committee of the Vrije Universiteit and the eight participating hospitals, and declared exempt from the Medical Research Involving Human Subjects Act (WMO). The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki. The study protocol was registered in the Clinical Trials Registry (ClinicalTrials.gov; NCT05250882). All patients provided written informed consent prior to participation in this study. Participants All patients scheduled for elective colorectal surgery involving the creation of an anastomosis were eligible for inclusion. Patients were included regardless of whether the indication for resection was benign or malignant, and the construction of a diverting stoma was permitted. Exclusion criteria included age under eighteen years, emergency surgery, and inability to comprehend the informed consent form. All patients in this study received treatment according to the complete DoubleCheck enhanced care bundle [ 13 ]. Outcomes The primary outcome of this study was the incidence of preoperative anemia following the implementation of active screening in accordance with the enhanced care bundle. Additionally, the study examined the effect of preoperative anemia correction and compliance with the enhanced care bundle. Anemia was defined as a blood hemoglobin level < 7.5 mmol/L (12.1 g/dL) for females and < 8.0 mmol/L (12.9 g/dL) for males, combined with a ferritin level < 30.0 𝜇g/L, or the specified hemoglobin levels with ferritin between 30.0-100.0 𝜇g/L, transferrin saturation 5.0 mg/L [ 14 , 15 ]. Anemia severity was classified as severe (< 6.0 mmol/L; 7.0 mmol/L; >11.3 g/dL). Changes in hemoglobin levels were categorized as decreased when levels dropped by > 0.5 mmol/L, increased when elevated by > 0.5 mmol/L and unchanged when within the range of -0.5 and 0.5 mmol/L. Secondary outcomes included the effects of active preoperative screening and anemia correction on CAL, as well as postoperative outcomes and mortality. These secondary outcomes were collected at 30 and 90 days postoperatively. CAL was defined using Reisinger’s criteria and categorized according to both the International Study Group of Rectal Cancer (ISREC) and Clavien-Dindo (CD) classifications [ 16 – 18 ]. Other postoperative complications, including ileus, delayed gastric emptying, pneumonia, wound infection, bleeding, and atrium fibrillation, were determined and classified according to the CD classification. Intervention Preoperative blood tests, including hemoglobin, ferritin, transferrin saturation, and CRP, were performed during the patients’ initial visit at the outpatient clinic. If abnormalities were detected, the patient was referred for anemia correction. Intravenous ferric (III) carboxymaltose was recommended for treatment, although the final decision between intravenous or oral iron supplementation was left to the discretion of the clinician [ 15 , 19 ]. After iron treatment, the hemoglobin level was remeasured during preoperative hospital admission. Additionally, a hemoglobin measurement was conducted during the perioperative time-out moment in all patients. While there were no strict guidelines for postoperative hemoglobin monitoring, it was recommended to determine the hemoglobin level at least once before hospital discharge. Table 1 provides detailed recommendations for anemia detection and treatment. Table 1 – Anemia detection and correction Timing Cut-off values Action Preoperative phase Outpatient clinic Always (Hb, Fe, Tr-Sat, CRP) Hb ♀ < 7.5 mmol/L + Fe < 30 µg/L Hb ♂ < 8 mmol/L + Fe 5 + Tsat < 20% + Fe 30–100 µg/L Administration ferric (III) carboxymaltose (preferably intravenous) Hospital admission If anemic at outpatient clinic (Hb) ♀ < 7.5; ♂ < 8 mmol/L - Perioperative phase Anastomosis creation Always (Hb) ♀ < 7.5; ♂ 500ml blood loss (Hb) According to local protocol Transfusion according to local protocol Before discharge Recommended (Hb) According to local protocol - Hb = hemoglobin; Fe = iron, Tr-Sat = transferrin saturation, CRP = c-reactive protein, POD1 = postoperative day one. The DoubleCheck enhanced care bundle was implemented in patients undergoing colorectal surgery [ 13 ]. The bundle included anemia correction, hyperglycemia detection, maintenance of normothermia, correct timing of antibiotic prophylaxis, avoidance of unnecessary vasopressive drugs administration, and abstention from epidural analgesia. Compliance with these interventions was assessed during an additional perioperative time-out moment, just prior to the creation of the anastomosis. At all times, clinicians were allowed to modify any intervention to ensue patient safety. Additional preoperative and perioperative safety measures, such as bowel decontamination, stapler-doughnut inspection, air-leak testing, ICG, and endoscopy were routinely performed, although practices varied across hospitals. The ERAS-guidelines were fully implemented before the study start [ 20 ]. Patient related (age, sex, ASA-score, body mass index, diabetes mellitus, comorbidities, smoking, alcohol use, drug use, pathology diagnosis, detection by screening program, tumor distance from the anal verge, neoadjuvant therapy) and surgery related (blood loss, blood transfusion, oxygen saturation, mean arterial pressure, urine output, fluid administration, surgery duration, surgical procedure, surgical approach, anastomotic technique, perioperative events, additional procedures, contamination of the operative field, stoma placement and type) baseline characteristics were extracted from electronic patient files. Furthermore, information regarding the postoperative course (length of stay, intensive care unit stay, readmission, re-interventions, complications) and mortality were collected. Additionally, data on the presence of anemia, the progression of related blood measurements, and the treatment of pre-, peri- and postoperative anemia were also gathered in this manner. Statistical analysis The collected study data were analyzed using the Statistical Package for the Social Sciences software (SPSS version 28.0, Chicago (IL), USA). Patients with missing blood levels data necessary for the diagnosis of anemia were excluded from the analysis. Descriptive statistics were used to examine differences in baseline variables and study outcomes. Categorical variables were presented as proportions (%) and analyzed using a Pearson’s X-test or ANOVA-test. Continuous variables were reported as means (standard deviation) or medians (interquartile range), and analyzed using a Student t-test or Mann-Whitney U-test, depending on the skewness of the data. A p values of < 0.05 was considered statistically significant. Subsequently, additional subgroup analyses were conducted using similar statistical methods. Results Baseline characteristics Detailed information on the detection and correction of anemia was available for 899 DoubleCheck patients (99.7%). The study population was 54.2% male (n = 487), with a median age of 68 years (18–92 years) old. Of the patients, 15.1% (n = 122) underwent surgery for benign indications, while 84.9% (n = 686) underwent surgery for malignant indications. The surgical procedures performed included right-sided hemicolectomy in 39.7% (n = 357) of the cases, ileocoecal resection in 1.9% (n = 17), transversal resection in 2.4% (n = 22), left-sided hemicolectomy in 8.7% (n = 78), sigmoidectomy in 26.1% (n = 235), total mesorectal excision (TME) or low aneterior resection (LAR) in 16.2% (n = 146), transanal total mesorectal excision (TaTME) in 1.1% (n = 10), and other procedures in 3.8% (n = 34). Additionally, 3.6% (n = 32) of the study population received a diverting stoma (1.6% in colon vs. 12.2% in rectum resections). Preoperative anemia Preoperative hemoglobin and ferritin levels were measured in 97.1% (n = 873) of the patients. The mean hemoglobin level was 7.9 mmol/L (12.7 g/dL). The incidence of anemia at the initial outpatient clinic visit was 35.0% (n = 315), which was not statistically different in male patients compared to female patients (34.3% vs. 38.2%, p = 0.235). Severe preoperative anemia was present in 29.5% (n = 93) of the patients, mild in 35.2% (n = 111), and minor in 35.2% (n = 111). Table 2 presents the baseline characteristics of anemic versus the non-anemic patients. Patients with preoperative anemia were significantly older (67 vs. 74 years, p < 0.001), had a higher mean ASA-score (2.1 vs. 2.4, p < 0.001) and were more frequently diabetic (8.3% vs. 18.9%, p < 0.001), compared to non- anemic patients. Additionally, the types of surgical procedures performed differed significantly between the two groups (p < 0.001), and preoperative anemia was more prevalent in patients with malignant diseases (81.9% vs. 90.7%, p < 0.001). The mean blood loss (85 vs. 101 ml, p < 0.001) and number of perioperative blood transfusion (0.4% vs. 3.2%, p < 0.001) were significantly higher in the anemic group. Perioperative hyperglycemia was more common among anemic patients (7.8% vs. 16.4%, p < 0.001), while the other DoubleCheck risk factors hypothermia (p = 0.973), incorrect antibiotic prophylaxis (p = 0.753), vasopressors (p = 0.314), and epidural analgesia (p = 0.109) did not differ significantly between the anemic and non-anemic groups. Table 2 – Baseline characteristics: preoperative anemia No anemia (n = 558) Anemia (n = 315) p value Preoperative Age (years) 67 (16) 74 (16) < 0.001 Sex (male) 55.9% (312) 51.7% (163) 0.235 ASA-score 2 (0) 2 (1) < 0.001 BMI (kg/m 2 ) 25.8 (5) 25.4 (5) 0.474 Diabetes mellitus (yes) 8.3% (45) 18.9% (58) < 0.001 Pathology (malign) 81.9% (406) 90.7% (262) 14 packyears (yes) 44.4% (84) 41.9% (44) 0.674 Alcohol (yes) 59.8% (317) 46.2% (140) 4 unites per day (yes) 1.4% (4) 0.8% (1) 0.640 Drugs (yes) 1.3% (7) 0 0.054 Perioperative Procedure < 0.001 Right-sided hemicolectomy 26.2% (146) 54.9% (173) Extended right-sided hemicolectomy 3.2% (18) 4.4% (14) Ileocoecal resection 1.8% (10) 1.9% (6) Transversum resection 1.6% (9) 3.5% (11) Left-sided hemicolectomy 9.5% (53) 7.6% (24) LAR/TME 21.0% (117) 7.3% (23) TaTME 1.1% (6) 0.6% (2) Sigmoidectomy 30.8% (172) 17.8% (56) Other 4.9% (27) 1.9% (6) Surgery duration (min) 142 (56) 150 (60) 0.309 Surgical approach (open) 1.3% (7) 1.9% (6) 0.562 Blood loss (ml) 50 (80) 50 (130) < 0.001 Intraoperative blood transfusion (yes) 0.4% (2) 3.2% (10) < 0.001 Intraoperative event (yes) 4.6% (25) 6.4% (20) 0.255 Stoma (yes) 3.0% (17) 4.4% (14) 0.284 Additional organ resection (yes) 21.4% (117) 23.2% (72) 0.559 Hyperglycemia (yes) 7.8% (42) 16.4% (49) < 0.001 Hypothermia (yes) 54.4% (301) 54.3% (170) 0.973 Incorrect antibiotic prophylaxis (yes) 1.1% (6) 1.3% (4) 0.735 Vasopressors (yes) 60.0% (335) 63.5% (200) 0.314 Epidural (yes) 2.7% (15) 4.8% (15) 0.109 Categorical variables are expressed as proportions (%) and continuous variables as medians (interquartile range). P values < 0.05 were considered statistically significant. Preoperative correction of anemia Following the diagnosis of anemia, 77.4% (n = 192) of patients were treated according to the enhanced care bundle. Among these, 87.9% (n = 167) received intravenous iron transfusions, while 12.1% (n = 23) were given oral iron suppletion in the weeks leading up to surgery. In the treatment group, hemoglobin levels decreased in 4.2% (n = 13) of patients, remained unchanged in 45.8% (n = 143), and increased in 50.0% (n = 156). The mean hemoglobin level during creation of the anastomosis was 8.2 mmol/L (13.2 g/dL). Perioperative anemia was observed in 32.3% (n = 290) of the patients. A severe preoperative anemia was present in 6.2% (n = 18) of the patients, mild in 37.6% (n = 109), and minor in 56.2% (n = 163), which was significantly different from preoperative measurements (p < 0.001) (Table 3 ). Table 3 – Preoperative anemia correction Blood measurements Preoperative Perioperative p value Hemoglobin (mmol/L) 7.9 (3.1–11.4) 8.2 (4.2–12.5) < 0.001 Anemia (yes) 35.0% (315) 32.3% (290) < 0.001 Severe (< 6 mmol/L) 29.5% (93) 6.2% (18) 7 mmol/L) 35.2% (111) 56.2% (163) Correction of preoperative anemia From anemic to non-anemic 23.4% (73) Change in hemoglobin level Unchanged (-0.5-0.5 mmol/L) 45.8% (143) Declined (> 0.5 mmol/L) 4.2% (13) Increased (> 0.5 mmol/L) 50.0% (156) Categorical variables are expressed as proportions (%) and continuous variables as medians (range). P values < 0.05 were considered statistically significant. Table 4 outlines the differences between the preoperative iron treatment group and non-treatment group. Age, sex and comorbidities were not significantly different between the two groups. Patients who received preoperative anemia correction underwent significantly different surgical procedures (p = 0.041) compared to those who did not receive iron treatment. Moreover, in the treatment group, exposure to hypothermia (66.1% vs. 50.5%, p = 0.040) was significantly lower, while the administration of vasopressive drugs (48.2% vs. 72.4%, p < 0.001) was significantly more frequent. Table 4 – Baseline characteristics: preoperative correction anemia Not corrected (n = 56) Corrected (n = 192) p value Preoperative Age (years) 73 (16) 75 (15) 0.246 Sex (male) 55.4% (31) 48.4% (93) 0.362 ASA-score 2 (1) 2 (1) 0.210 BMI (kg/m 2 ) 25.4 (5) 25.6 (5) 0.734 Diabetes mellitus (yes) 10.7% (6) 21.5% (41) 0.071 Pathology (malign) 86.8% (46) 93.8% (165) 0.141 Neoadjuvant therapy (yes) 12.0% (6) 4.5% (8) 0.316 Intoxications Current smoker (yes) 3.6% (2) 7.4% (14) 0.472 >14 packyears (yes) 42.9% (6) 50.7% (35) 0.591 Alcohol (yes) 48.1% (25) 48.7% (91) 0.940 >4 unites per day (yes) 4.3% (1) 1.2% (1) 0.392 Drugs (yes) 0 0 - Perioperative Procedure 0.041 Right-sided hemicolectomy 48.2% (27) 63.5% (122) Extended right-sided hemicolectomy 1.8% (1) 5.2% (10) Ileocoecal resection 1.8% (1) 0.5% (1) Transversum resection 5.4% (3) 2.6% (5) Left-sided hemicolectomy 1.8% (1) 6.3% (12) LAR/TME 8.9% (5) 7.8% (15) TaTME 0 1.0% (2) Sigmoidectomy 28.6% (16) 10.9% (21) Other 3.6% (2) 2.1% (4) Surgery duration (min) 150 (79) 147 (63) 0.287 Surgical approach (open) 1.8% (1) 2.1% (4) 1 Blood loss (ml) 50 (130) 50 (80) 0.901 Intraoperative blood transfusion (yes) 7.1% (4) 3.1% (6) 0.240 Intraoperative event (yes) 7.1% (4) 6.8% (13) 1 Stoma (yes) 3.6% (2) 5.7% (11) 0.738 Additional organ resection (yes) 26.8% (15) 22.6% (43) 0.591 Hyperglycemia (yes) 10.9% (6) 16.5% (30) 0.313 Hypothermia (yes) 66.1% (37) 50.5% (96) 0.040 Incorrect antibiotic prophylaxis (yes) 0 2.1% (4) 0.577 Vasopressors (yes) 48.2% (27) 72.4% (139) < 0.001 Epidural (yes) 7.1% (4) 3.1% (6) 0.240 Categorical variables are expressed as proportions (%) and continuous variables as medians (interquartile range). P values < 0.05 were considered statistically significant. After correction of preoperative anemia, changes in hemoglobin levels were significantly associated with the duration of surgery (155 vs. 142 vs. 155 min, p = 0.037) and administration of vasopresssive drugs (76.9% vs. 70.5% vs. 54.5%, p = 0.010) (Table 5 ). Table 5 – Baseline characteristics: hemoglobin change after correction Unchanged (n = 143) Declined (n = 13) Increased (n = 156) p value Preoperative Age (years) 73 (18) 69 (19) 74 (15) 0.502 Sex (male) 53.1% (76) 76.9% (10) 48.7% (76) 0.137 ASA-score 2 (1) 3 (1) 2 (1) 0.798 BMI (kg/m 2 ) 25.4 (5) 23.8 (6) 25.4 (5) 0.703 Diabetes mellitus (yes) 17.3% (24) 15.4% (2) 21.2% (32) 0.672 Pathology (malign) 88.3% (113) 100% (11) 91.8% (135) 0.332 Neoadjuvant therapy (yes) 8.6% (11) 8.3% (1) 4.8% (7) 0.130 Intoxications Current smoker (yes) 6.3% (9) 15.4% (2) 7.1% (11) 0.138 >14 packyears (yes) 42.1% (16) 40.0% (2) 42.6% (26) 0.993 Alcohol (yes) 43.5% (60) 41.7% (5) 50.0% (75) 0.508 >4 unites per day (yes) 1.8% (1) 0 1.5% (1) 0.918 Drugs (yes) 0 0 0 - Perioperative Procedure 0.170 Right-sided hemicolectomy 46.2% (66) 61.5% (8) 62.2% (97) Extended right-sided hemicolectomy 4.2% (6) 0 5.1% (8) Ileocoecal resection 3.5% (5) 0 0.6% (1) Transversum resection 4.9% (7) 0 2.6% (4) Left-sided hemicolectomy 10.5% (15) 7.7% (1) 5.1% (8) LAR/TME 7.7% (11) 7.7% (1) 7.1% (11) TaTME 0 7.7% (1) 0.6% (1) Sigmoidectomy 21.7% (31) 15.4% (2) 14.7% (23) Other 1.4% (2) 0 1.9% (3) Surgery duration (min) 150 (75) 155 (99) 142 (57) 0.037 Surgical approach (open) 1.4% (2) 0 2.6% (4) 0.594 Blood loss (ml) 50 (130) 100 (88) 50 (79) 0.592 Intraoperative blood transfusion (yes) 4.2% (6) 7.7% (1) 1.9% (3) 0.370 Intraoperative event (yes) 8.5% (12) 15.4% (2) 3.9% (6) 0.110 Stoma (yes) 2.8% (4) 7.7% (1) 5.1% (8) 0.487 Additional organ resection (yes) 23.6% (33) 15.4% (2) 23.2% (36) 0.797 Hyperglycemia (yes) 16.9% (23) 15.4% (2) 15.6% (23) 0.956 Hypothermia (yes) 60.1% (86) 30.8% (4) 50.6% (78) 0.058 Incorrect antibiotic prophylaxis (yes) 2.1% (3) 0 0.6% (1) 0.452 Vasopressors (yes) 54.5% (78) 76.9% (10) 70.5% (110) 0.010 Epidural (yes) 6.3% (9) 7.7% (1) 3.2% (5) 0.406 Categorical variables are expressed as proportions (%) and continuous variables as medians (interquartile range). P values < 0.05 were considered statistically significant. Secondary outcomes CAL was observed in 6.1% (n = 53) of the patients. The severity of CAL was classified as ISREC Grade A in 0%, Grade B in 9.4% (n = 5) and Grade C in 90.6% (n = 48). The incidence of CAL was not significantly associated with the correction of preoperative anemia (p = 0.607) or with changes in hemoglobin levels after iron treatment (p = 0.736). Moreover, there was no significant relationship between the severity of CAL and preoperative correction or changes in hemoglobin levels (p = 0.318 and p = 0.192 respectively). The postoperative course is summarized in Table 6 . The median length of stay was 4 days, which did not differ between patients with corrected and non-correction preoperative anemia (p = 0.975) or changes in hemoglobin levels after iron treatment (p = 0.325). The incidence and severity of other postoperative complications did not differ significantly between the corrected and non-corrected group (p = 0.494 and p = 0.235 respectively). Furthermore, changes in hemoglobin levels after correction were not associated with the occurrence or severity of postoperative complications (p = 0.776 and p = 0.548 respectively). Intensive care unit stay (p = 0.058) and hospital readmissions (p = 0.488) also showed no significant differences between the corrected and non-corrected groups, nor were they related to in hemoglobin levels after iron treatment (p = 0.177 and p = 0.521 respectively). The mortality rate was 0.8% (n = 7) and was not significantly different between the corrected and non-corrected groups or changes in hemoglobin levels after iron treatment (p = 0.541 and p = 0.838 respectively). Table 6 – Postoperative course Correction of preoperative anemia Not corrected (n = 56) Corrected (n = 192) p value CAL (yes) 3.6% (2) 5.3% (10) 0.607 Grade A 0 0 0.318 Grade B 50.0% (1) 10.0% (1) Grade C 50.0% (1) 90.0% (9) Other complications (yes) 23.2% (13) 19.0% (36) 0.494 Grade I 30.7% (4) 24.9% (9) 0.235 Grade II 38.5% (5) 47.2% (17) Grade IIIa 15.4% (2) 5.6% (2) Grade IIIb 0 13.9% (5) Grade IVa 7.7% (1) 0 Grade IVb 0 2.8% (1) Grade V 7.7% (1) 5.6% (2) Length of stay (days) 4 (4) 4 (4) 0.975 Intensive care admission (yes) 12.5% (7) 4.7% (9) 0.058 Re-admission (yes) 7.3% (4) 10.4% (20) 0.488 Death (yes) 1.8% (1) 1.1% (2) 0.541 Differences in hemoglobin level after correction Unchanged (n = 143) Declined (n = 13) Increased (n = 156) p value CAL (yes) 4.3% (6) 0 4.5% (7) 0.736 Grade A 0 0 0 0.192 Grade B 33.3% (2) 0 0 Grade C 66.7% (4) 0 100% (7) Other complications (yes) 20.4% (29) 15.4% (2) 17.5% (27) 0.776 Grade I 28.0% (8) 0 33.4% (9) 0.548 Grade II 41.1% (12) 50.0% (1) 44.4% (12) Grade IIIa 10.3% (3) 0 7.4% (2) Grade IIIb 10.3% (3) 0 7.4% (2) Grade IVa 0 50.0% (1) 0 Grade IVb 3.4% (1) 0 0 Grade V 6.9% (2) 0 7.4% (2) Length of stay (days) 5 (3) 4 (4) 4 (3) 0.325 Intensive care admission (yes) 9.1% (13) 7.7% (1) 3.8% (6) 0.177 Re-admission (yes) 9.2% (13) 0 8.3% (13) 0.521 Death (yes) 1.4% (2) 0 1.3% (2) 0.838 Categorical variables are expressed as proportions (%) and continuous variables as medians (interquartile range). P values 0.5 mmol/L, increased when elevated > 0.5 mmol/L and unchanged between − 0.5 and 0.5 mmol/L. CAL gradation according to ISREC; other complications gradation according to CD. Discussion This study demonstrated a reduction in the incidence and severity of perioperative anemia following the introduction of an enhanced care bundle. The enhanced care bundle facilitated early and consistent detection and treatment of preoperative anemia in patients undergoing elective colorectal surgery. In recent years, the significant impact of preoperative anemia on postoperative complications has become increasingly evident. As a result, anemia management has gained prominence in prehabilitation and other preoperative optimization care bundles aimed at reducing overall morbidity. However, this approach had not previously been consistently integrated into colorectal care pathways and The DoubleCheck study was the first to achieve this in a prospective multicenter trial [ 13 ]. This prospective sub-analysis of the DoubleCheck study provided valuable insights into the role of preoperative anemia correction on perioperative and postoperative outcomes. Our findings revealed a significant association between perioperative hyperglycemia and preoperative anemia (p < 0.001). This observation may be partially explained by the higher prevalence of diabetes mellitus in patients with preoperative anemia (7.8% vs. 16.4%, p < 0.001). However, the association remained significant in the subgroup analysis of the patients without diagnosed diabetes (Table 7 ). The relationship between anemia and hyperglycemia has been established previously, with proposed explanations suggesting that low hemoglobin levels are linked to an impaired glucose hemostasis and poor glycemic control [ 21 , 22 ]. Moreover, both type 1 and type 2 diabetes mellitus are known to exacerbate anemia. These interrelated factors underline the importance of simultaneously optimizing all risk factors for CAL. Table 7 – Subgroup analysis perioperative hyperglycemia Diabetes mellitus No diabetes mellitus Anemia No anemia Anemia No anemia Hyperglycemia 46.4% (26) 50.0% (22) Hyperglycemia 9.4% (22) 4.0% (19) No hyperglycemia 53.6% (30) 50.0% (22) No hyperglycemia 90.6% (213) 96.0% (459) p = 0.723 p = 0.004 Variables are expressed as proportions (%). P values < 0.05 were considered statistically significant. This study did not demonstrate a significant association between the correction of preoperative anemia and postoperative complications, nor with changes in hemoglobin levels following anemia correction. This outcome may be attributed to the study’s focus on the effect of anemia correction alone, despite the fact that the overall intervention encompassed six distinct sub-interventions. The preventive impact of each individual sub-intervention on postoperative complications may be too subtle to detect when examined individually. Furthermore, optimizing multiple factors simultaneously may have a synergistic effect on the enhancement of the patient’s perioperative condition. Both outcomes indicate that anemia may be more accurately regarded as an indicator of overall poor physiological fitness rather than as an isolated risk factor. The definition of anemia and the established hemoglobin cut-off value remain a topic of ongoing debate. According to the World Health Organization, anemia is defined as “a condition in which the number of red blood cells or the hemoglobin concentration within them is lower than normal (< 13.0 g/dL in male, < 12.0 g/dL in female)” [ 23 ]. Commonly used cut-off values for hemoglobin levels vary between 7.0 and 8.5 mmol/L, with some studies employing gender-specific thresholds. For instance, Beutler et al. (2006) identified hemoglobin cut-off levels of 8.5 mmol/L (13.7 g/dL) in males and 7.6 mmol/L (12.2 g/dL) in females in a comprehensive literature review [ 24 ]. However, more recent studies suggested a lower cut-off value of 7.4 mmol/L (12.0 g/dL), while others propose optimal cut-off values of 8.4 mmol/L (13.5 g/dL) in males and 7.4 mmol/L (12.0 g/dL) in females [ 25 , 26 ]. This lack of uniformity in cut-off values seems to depend on the specific investigated study population. Nevertheless, it is generally agreed that the cut-off values should differ for males and females, with males having higher thresholds, typically within the range of 7.5 and 8.5 mmol/L. Furthermore, although intravenous iron transfusion in generally found to be more effective than oral supplementation, practice variations still frequently occur in daily practice [ 9 , 27 ]. This variation may be attributable to the difference in costs, with intravenous transfusions being approximately six times more expensive compared to oral supplementation [ 28 ]. Given the limited time between diagnosis and surgery, oral iron suppletion may not elevate hemoglobin levels rapidly enough, leading to preference for intravenous administration. In addition, colorectal cancer is associated with alterations in iron absorption, which can impair the efficacy of oral iron supplements [ 29 ]. Therefore, intravenous iron supplementation is particularly advantageous for oncological patients, who have a higher prevalence of preoperative anemia (81.9% vs. 90.7%, p < 0.001). While the difference between intravenous and oral iron treatment has been less thoroughly studied in patients with benign surgical indications, intravenous iron transfusions also appear to be the preferable option in this subgroup [ 30 ]. A strength of this study is its international, multicenter and prospective design. Additionally, the proposed approach for anemia detection and correction involved widely accessible, simple, and cost-effective interventions, making it feasible for global implementation in colorectal care pathways. However, the study had some limitations, including the potential confounding effects of other safety procedures aimed at reducing postoperative complications. Nonetheless, we believe these factors had minimal impact on hemoglobin levels and the availability of optimization resources. In conclusion, the study demonstrated that early detection and correction of preoperative anemia is achievable with the implementation of the DoubleCheck enhanced care bundle. Preoperative anemia may be more indicative of overall poor physiological fitness rather than an isolated factor. Implementation of early and consistent preoperative anemia detection and correction will enhance the quality of care for patients undergoing elective colorectal surgery. Declarations Competing Interests FD received an educational grant from Medtronic. Medtronic had no role in the study design, data collection, data analysis, data interpretation or writing of the manuscript. All other authors declare no conflict of interests. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethical Committee of the Vrije Universiteit and the eight participating hospitals (16-03-2021; 2020.0634), and declared exempt from the Medical Research Involving Human Subjects Act (WMO). Funding This study was funded by Medtronic. Author Contribution AdW, BTB, DEH, GK and FD were involved in study conceptualization and design. All stated authors and contributors were involved in data acquisition and had full access to all study data. AdW and FD verified the data, did the analysis and interpretation of this data and wrote the original manuscript draft. FD and GK provided supervision during all phases of this study. All authors revised the manuscript critically for important intellectual content and provided final approval of the version to be published. Acknowledgement The Taskforce Anastomotic Leakage is part of the Dutch Society of Colorectal Surgery and consists of drs. Anne de Wit (Amsterdam UMC), drs. Boukje T. Bootsma (Amsterdam UMC), drs. Daitlin E. Huisman (Amsterdam UMC), dr. Bob van Wely (Bernhoven), dr. Julie van Hoogstraten (Bernhoven), dr. Dirk J.A. Sonneveld (Dijklander), dr. Daan Moes (Dijklander), dr. Johannes A. Wegdam (Elkerliek), prof. dr. Carlo V. Feo (Ferrara), dr. Emiel G.G. Verdaasdonk (Jeroen Bosch), dr. Walter J.A. Brokelman (Jeroen Bosch), drs. David W.G. ten Cate (Maxima MC), dr. Tim Lubbers (Maastricht UMC+), dr. Emmanuel Lagae (ZorgSaam), dr. David J.G.H. Roks (ZorgSaam), prof. dr. Geert Kazemier (Amsterdam UMC), dr. Jurre Stens (Leeuwarden MC), dr. Gerrit D. Slooter (Maxima MC) and dr. Freek Daams (Amsterdam UMC). Medtronic awarded an educational grant to FD, which was used to hire multiple junior researchers over several years. Part of their activities was executing the DoubleCheck study. Medtronic had no role in study design, data collection, data analysis, data interpretation or writing of the manuscript. All authors take full responsibility for the integrity and completeness of the content of this manuscript. Data Availability De-identified individual participant data collected in this study and additional relevant related documents can be made available upon request by contacting AdW ( [email protected] ) or FD ( [email protected] ). There are no date restrictions on the availability of the data. The investigators will be allowed to approve all research conducted with the shared data. References Zarnescu, E. C., Zarnescu, N. O., & Costea, R. (2021). Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery. 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Annals Of Surgery. https://doi.org/10.1097/sla.0000000000006442 Reudink, M., Huisman, D. E., Slooter, G. D., & Daams, F. (2021). Response to the Comment on “LekCheck: A Prospective Study to Identify Perioperative Modifiable Risk Factors for Anastomotic Leakage in Colorectal Surgery”. Annals Of Surgery, 274(6), e852–e853. https://doi.org/10.1097/sla.0000000000004880 Bootsma, B. T., Huisman, D. E., Reudink, M., De Wit, A., Feo, C., Hering, J., Hompes, R., Komen, N., Lagae, E. A., Lubbers, T., Müller, C. S., Van Der Pas, S. L., Stassen, L. P., Stens, J., Sonneveld, D. J., Verdaasdonk, E. G., Van Velzen, C., Wegdam, J. A., Van Wely, B.,.. . Daams, F. (2024). Enhanced perioperative care for the prevention of anastomotic leakage – DOUBLE CHECK: study protocol for an international, multicenter open-label trial with historical controls. International Journal Of Surgery Protocols. https://doi.org/10.1097/sp9.0000000000000014 Reisinger, K. W., Poeze, M., Hulsewé, K. W. E., Van Acker, B. A., Van Bijnen, A. A., Hoofwijk, A. G. M., Stoot, J. H. M. B., & Derikx, J. P. M. (2014). Accurate Prediction of Anastomotic Leakage after Colorectal Surgery Using Plasma Markers for Intestinal Damage and Inflammation. Journal Of The American College Of Surgeons, 219(4), 744–751. https://doi.org/10.1016/j.jamcollsurg.2014.06.011 Rahbari, N. N., Weitz, J., Hohenberger, W., Heald, R. J., Moran, B., Ulrich, A., Holm, T., Wong, W. D., Tiret, E., Moriya, Y., Laurberg, S., Dulk, M. D., Van de Velde, C., & Büchler, M. W. (2010). Definition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the International Study Group of Rectal Cancer. Surgery, 147(3), 339–351. https://doi.org/10.1016/j.surg.2009.10.012 Dindo, D., Demartines, N., & Clavien, P. A. (2004). Classification of Surgical Complications. Annals Of Surgery, 240(2), 205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae Talboom, K., Borstlap, W. A. A., Roodbeen, S. X., Bruns, E. R. J., Buskens, C. J., Hompes, R., Tytgat, K. M. A. J., Tuynman, J. B., Consten, E. C. J., Heuff, G., Kuiper, T., Van Geloven, A. A. W., Veldhuis, G. J., Van Der Hoeven, J. A. B., De Castro, S. M. M., Sietses, C., Spinelli, A., Van de Ven, A. W. H., Van Der Zaag, E. S.,.. . Van Oostendorp, S. (2023). Ferric carboxymaltose infusion versus oral iron supplementation for preoperative iron deficiency anaemia in patients with colorectal cancer (FIT): a multicentre, open-label, randomised, controlled trial. The Lancet Haematology, 10(4), e250–e260. https://doi.org/10.1016/s2352-3026(22)00402-1 Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., Rockall, T. A., Young-Fadok, T. M., Hill, A. G., Soop, M., De Boer, H. D., Urman, R. D., Chang, G. J., Fichera, A., Kessler, H., Grass, F., Whang, E. E., Fawcett, W. J., Carli, F.,.. . Ljungqvist, O. (2018). Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World Journal Of Surgery, 43(3), 659–695. https://doi.org/10.1007/s00268-018-4844-y Food & Nutrition Action in Health Systems (AHS). (2024, 5 maart). Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. https://www.who.int/publications/i/item/9789240088542 Beutler, E., & Waalen, J. (2006). The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood, 107(5), 1747–1750. https://doi.org/10.1182/blood-2005-07-3046 Silberstein, L. E., & Anastasi, J. (2012). Hematology E-Book: Basic Principles and Practice, Expert Consult Premium Edition - Enhanced Online Features. Elsevier Health Sciences. Ludwig, H., Van Belle, S., Barrett-Lee, P., Birgegård, G., Bokemeyer, C., Gascón, P., Kosmidis, P., Krzakowski, M., Nortier, J., Olmi, P., Schneider, M., & Schrijvers, D. (2004). 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P., Sandri, Y. P., Mallet, E. K. V., & Frizzo, M. N. (2015). Anemia in Patients with Type 2 Diabetes Mellitus. Anemia, 2015, 1–7. https://doi.org/10.1155/2015/354737 Additional Declarations Competing interest reported. FD received an educational grant from Medtronic. Medtronic had no role in the study design, data collection, data analysis, data interpretation or writing of the manuscript. All other authors declare no conflict of interests. Cite Share Download PDF Status: Published Journal Publication published 05 Apr, 2025 Read the published version in Techniques in Coloproctology → Version 1 posted Editorial decision: Revision requested 20 Dec, 2024 Reviews received at journal 29 Nov, 2024 Reviewers agreed at journal 26 Nov, 2024 Reviewers invited by journal 08 Nov, 2024 Editor assigned by journal 07 Nov, 2024 Submission checks completed at journal 25 Oct, 2024 First submitted to journal 25 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5331736","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":370587697,"identity":"9cee9f55-d4d3-4dac-9663-7d5735f6ac29","order_by":0,"name":"Anne de Wit","email":"","orcid":"","institution":"Amsterdam University Medical Centers","correspondingAuthor":false,"prefix":"","firstName":"Anne","middleName":"","lastName":"de Wit","suffix":""},{"id":370587698,"identity":"c63905cb-2e96-4fd0-9422-b77cf65504f7","order_by":1,"name":"Boukje T. 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FD received an educational grant from Medtronic. Medtronic had no role in the study design, data collection, data analysis, data interpretation or writing of the manuscript. All other authors declare no conflict of interests.","formattedTitle":"Early detection and correction of preoperative anemia in patients undergoing colorectal surgery – a prospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eColorectal anastomotic leakage (CAL) is one of the most severe complications, occurring in 2\u0026ndash;19% of patients undergoing colorectal surgery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Given that CAL can lead to abdominal sepsis, the necessity for stoma formation, increased mortality and heightened hospital costs, various strategies have been proposed to prevent this dreadful complication [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Recently, the focus has shifted towards identifying modifiable risk factors for CAL to develop the most effective preventive strategies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePerioperative anemia has been identified as the most significant modifiable risk factor for CAL in a large international trial (OR 5.4, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although some studies have reported conflicting results, the majority have demonstrated a significant association between preoperative anemia and the incidence of CAL [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The prevalence of preoperative anemia varies between 22% and 67%, depending on the specific definition of anemia and the hemoglobin cut-off values used [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Anemia is particularly prevalent in colorectal cancer patients, with an increased incidence of 40\u0026ndash;80%, primarily due to intraluminal blood loss from the tumor site [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePreoperative anemia is predominantly caused by iron deficiency, which arises from impaired iron absorption, reduced iron availability, nutrient deficiencies, and occult intraluminal blood loss [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This leads to a reduced production of hemoglobin. The shortage of circulating hemoglobin impairs perfusion and oxygenation at the newly constructed anastomosis, both of which are critical for tissue healing, thereby increasing the risk of CAL [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite evidence indicating that preoperative anemia is a significant predictor of CAL and an important target for optimization, it is not consistently detected and corrected during the preoperative phase. Furthermore, a standardized care pathway for optimizing preoperative anemia in patients undergoing colorectal surgery is not available. The recent DoubleCheck study was the first to implement an enhanced care bundle, which consisted of early detection and correction of preoperative anemia, among other interventions [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The aim of this study was to obtain detailed information on the impact of early detection and correction of preoperative anemia on perioperative and postoperative outcomes in patients undergoing colorectal surgery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis open-labelled interventional study was conducted between September 2021 and December 2023 across eight European hospitals. It was designed as a prospective sub-analysis of the DoubleCheck study [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Ethical approval was obtained from the Ethical Committee of the Vrije Universiteit and the eight participating hospitals, and declared exempt from the Medical Research Involving Human Subjects Act (WMO). The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki. The study protocol was registered in the Clinical Trials Registry (ClinicalTrials.gov; NCT05250882). All patients provided written informed consent prior to participation in this study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eAll patients scheduled for elective colorectal surgery involving the creation of an anastomosis were eligible for inclusion. Patients were included regardless of whether the indication for resection was benign or malignant, and the construction of a diverting stoma was permitted. Exclusion criteria included age under eighteen years, emergency surgery, and inability to comprehend the informed consent form. All patients in this study received treatment according to the complete DoubleCheck enhanced care bundle [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe primary outcome of this study was the incidence of preoperative anemia following the implementation of active screening in accordance with the enhanced care bundle. Additionally, the study examined the effect of preoperative anemia correction and compliance with the enhanced care bundle. Anemia was defined as a blood hemoglobin level\u0026thinsp;\u0026lt;\u0026thinsp;7.5 mmol/L (12.1 g/dL) for females and \u0026lt;\u0026thinsp;8.0 mmol/L (12.9 g/dL) for males, combined with a ferritin level\u0026thinsp;\u0026lt;\u0026thinsp;30.0 \u0026#120583;g/L, or the specified hemoglobin levels with ferritin between 30.0-100.0 \u0026#120583;g/L, transferrin saturation\u0026thinsp;\u0026lt;\u0026thinsp;15.0\u0026ndash;20.0%, and C-reactive protein\u0026thinsp;\u0026gt;\u0026thinsp;5.0 mg/L [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Anemia severity was classified as severe (\u0026lt;\u0026thinsp;6.0 mmol/L; \u0026lt;9.7 g/dL), mild (6.0\u0026ndash;7.0 mmol/L; 9.7\u0026ndash;11.3 g/dL) and minor (\u0026gt;\u0026thinsp;7.0 mmol/L; \u0026gt;11.3 g/dL). Changes in hemoglobin levels were categorized as decreased when levels dropped by \u0026gt;\u0026thinsp;0.5 mmol/L, increased when elevated by \u0026gt;\u0026thinsp;0.5 mmol/L and unchanged when within the range of -0.5 and 0.5 mmol/L.\u003c/p\u003e \u003cp\u003eSecondary outcomes included the effects of active preoperative screening and anemia correction on CAL, as well as postoperative outcomes and mortality. These secondary outcomes were collected at 30 and 90 days postoperatively. CAL was defined using Reisinger\u0026rsquo;s criteria and categorized according to both the International Study Group of Rectal Cancer (ISREC) and Clavien-Dindo (CD) classifications [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Other postoperative complications, including ileus, delayed gastric emptying, pneumonia, wound infection, bleeding, and atrium fibrillation, were determined and classified according to the CD classification.\u003c/p\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003ePreoperative blood tests, including hemoglobin, ferritin, transferrin saturation, and CRP, were performed during the patients\u0026rsquo; initial visit at the outpatient clinic. If abnormalities were detected, the patient was referred for anemia correction. Intravenous ferric (III) carboxymaltose was recommended for treatment, although the final decision between intravenous or oral iron supplementation was left to the discretion of the clinician [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. After iron treatment, the hemoglobin level was remeasured during preoperative hospital admission. Additionally, a hemoglobin measurement was conducted during the perioperative time-out moment in all patients. While there were no strict guidelines for postoperative hemoglobin monitoring, it was recommended to determine the hemoglobin level at least once before hospital discharge. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides detailed recommendations for anemia detection and treatment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Anemia detection and correction\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTiming\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCut-off values\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAction\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative phase\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutpatient clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways (Hb, Fe, Tr-Sat, CRP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHb ♀ \u0026lt; 7.5 mmol/L\u0026thinsp;+\u0026thinsp;Fe\u0026thinsp;\u0026lt;\u0026thinsp;30 \u0026micro;g/L\u003c/p\u003e \u003cp\u003eHb ♂ \u0026lt; 8 mmol/L\u0026thinsp;+\u0026thinsp;Fe\u0026thinsp;\u0026lt;\u0026thinsp;30 \u0026micro;g/L\u003c/p\u003e \u003cp\u003eOR CRP\u0026thinsp;\u0026gt;\u0026thinsp;5\u0026thinsp;+\u0026thinsp;Tsat\u0026thinsp;\u0026lt;\u0026thinsp;20% + Fe 30\u0026ndash;100 \u0026micro;g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdministration ferric (III) carboxymaltose (preferably intravenous)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIf anemic at outpatient clinic (Hb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e♀ \u0026lt; 7.5; ♂ \u0026lt; 8 mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerioperative phase\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomosis creation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlways (Hb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e♀ \u0026lt; 7.5; ♂ \u0026lt; 8 mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTransfusion according to local protocol\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative phase\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIf anemic at outpatient clinic (Hb)\u003c/p\u003e \u003cp\u003eOR\u0026thinsp;\u0026gt;\u0026thinsp;500ml blood loss (Hb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAccording to local protocol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTransfusion according to local protocol\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRecommended (Hb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAccording to local protocol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eHb\u0026thinsp;=\u0026thinsp;hemoglobin; Fe\u0026thinsp;=\u0026thinsp;iron, Tr-Sat\u0026thinsp;=\u0026thinsp;transferrin saturation, CRP\u0026thinsp;=\u0026thinsp;c-reactive protein, POD1\u0026thinsp;=\u0026thinsp;postoperative day one.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe DoubleCheck enhanced care bundle was implemented in patients undergoing colorectal surgery [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The bundle included anemia correction, hyperglycemia detection, maintenance of normothermia, correct timing of antibiotic prophylaxis, avoidance of unnecessary vasopressive drugs administration, and abstention from epidural analgesia. Compliance with these interventions was assessed during an additional perioperative time-out moment, just prior to the creation of the anastomosis. At all times, clinicians were allowed to modify any intervention to ensue patient safety. Additional preoperative and perioperative safety measures, such as bowel decontamination, stapler-doughnut inspection, air-leak testing, ICG, and endoscopy were routinely performed, although practices varied across hospitals. The ERAS-guidelines were fully implemented before the study start [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatient related (age, sex, ASA-score, body mass index, diabetes mellitus, comorbidities, smoking, alcohol use, drug use, pathology diagnosis, detection by screening program, tumor distance from the anal verge, neoadjuvant therapy) and surgery related (blood loss, blood transfusion, oxygen saturation, mean arterial pressure, urine output, fluid administration, surgery duration, surgical procedure, surgical approach, anastomotic technique, perioperative events, additional procedures, contamination of the operative field, stoma placement and type) baseline characteristics were extracted from electronic patient files. Furthermore, information regarding the postoperative course (length of stay, intensive care unit stay, readmission, re-interventions, complications) and mortality were collected. Additionally, data on the presence of anemia, the progression of related blood measurements, and the treatment of pre-, peri- and postoperative anemia were also gathered in this manner.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe collected study data were analyzed using the Statistical Package for the Social Sciences software (SPSS version 28.0, Chicago (IL), USA). Patients with missing blood levels data necessary for the diagnosis of anemia were excluded from the analysis. Descriptive statistics were used to examine differences in baseline variables and study outcomes. Categorical variables were presented as proportions (%) and analyzed using a Pearson\u0026rsquo;s X-test or ANOVA-test. Continuous variables were reported as means (standard deviation) or medians (interquartile range), and analyzed using a Student t-test or Mann-Whitney U-test, depending on the skewness of the data. A p values of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. Subsequently, additional subgroup analyses were conducted using similar statistical methods.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003eDetailed information on the detection and correction of anemia was available for 899 DoubleCheck patients (99.7%). The study population was 54.2% male (n\u0026thinsp;=\u0026thinsp;487), with a median age of 68 years (18\u0026ndash;92 years) old. Of the patients, 15.1% (n\u0026thinsp;=\u0026thinsp;122) underwent surgery for benign indications, while 84.9% (n\u0026thinsp;=\u0026thinsp;686) underwent surgery for malignant indications. The surgical procedures performed included right-sided hemicolectomy in 39.7% (n\u0026thinsp;=\u0026thinsp;357) of the cases, ileocoecal resection in 1.9% (n\u0026thinsp;=\u0026thinsp;17), transversal resection in 2.4% (n\u0026thinsp;=\u0026thinsp;22), left-sided hemicolectomy in 8.7% (n\u0026thinsp;=\u0026thinsp;78), sigmoidectomy in 26.1% (n\u0026thinsp;=\u0026thinsp;235), total mesorectal excision (TME) or low aneterior resection (LAR) in 16.2% (n\u0026thinsp;=\u0026thinsp;146), transanal total mesorectal excision (TaTME) in 1.1% (n\u0026thinsp;=\u0026thinsp;10), and other procedures in 3.8% (n\u0026thinsp;=\u0026thinsp;34). Additionally, 3.6% (n\u0026thinsp;=\u0026thinsp;32) of the study population received a diverting stoma (1.6% in colon vs. 12.2% in rectum resections).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePreoperative anemia\u003c/h3\u003e\n\u003cp\u003ePreoperative hemoglobin and ferritin levels were measured in 97.1% (n\u0026thinsp;=\u0026thinsp;873) of the patients. The mean hemoglobin level was 7.9 mmol/L (12.7 g/dL). The incidence of anemia at the initial outpatient clinic visit was 35.0% (n\u0026thinsp;=\u0026thinsp;315), which was not statistically different in male patients compared to female patients (34.3% vs. 38.2%, p\u0026thinsp;=\u0026thinsp;0.235). Severe preoperative anemia was present in 29.5% (n\u0026thinsp;=\u0026thinsp;93) of the patients, mild in 35.2% (n\u0026thinsp;=\u0026thinsp;111), and minor in 35.2% (n\u0026thinsp;=\u0026thinsp;111).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the baseline characteristics of anemic versus the non-anemic patients. Patients with preoperative anemia were significantly older (67 vs. 74 years, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), had a higher mean ASA-score (2.1 vs. 2.4, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and were more frequently diabetic (8.3% vs. 18.9%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), compared to non- anemic patients. Additionally, the types of surgical procedures performed differed significantly between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and preoperative anemia was more prevalent in patients with malignant diseases (81.9% vs. 90.7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mean blood loss (85 vs. 101 ml, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and number of perioperative blood transfusion (0.4% vs. 3.2%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly higher in the anemic group. Perioperative hyperglycemia was more common among anemic patients (7.8% vs. 16.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while the other DoubleCheck risk factors hypothermia (p\u0026thinsp;=\u0026thinsp;0.973), incorrect antibiotic prophylaxis (p\u0026thinsp;=\u0026thinsp;0.753), vasopressors (p\u0026thinsp;=\u0026thinsp;0.314), and epidural analgesia (p\u0026thinsp;=\u0026thinsp;0.109) did not differ significantly between the anemic and non-anemic groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Baseline characteristics: preoperative anemia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNo anemia (n\u0026thinsp;=\u0026thinsp;558)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAnemia (n\u0026thinsp;=\u0026thinsp;315)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ep value\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.9% (312)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.7% (163)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA-score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.8 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.4 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.474\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.3% (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.9% (58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathology (malign)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.9% (406)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.7% (262)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant therapy (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.7% (401)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.4% (269)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntoxications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoker (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.0% (61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4% (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;14 packyears (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.4% (84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.9% (44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.674\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.8% (317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.2% (140)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;4 unites per day (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrugs (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.3% (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerioperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight-sided hemicolectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.2% (146)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.9% (173)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtended right-sided hemicolectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2% (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.4% (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleocoecal resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8% (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransversum resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.6% (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft-sided hemicolectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.5% (53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.6% (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAR/TME\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.0% (117)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.3% (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaTME\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigmoidectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.8% (172)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.8% (56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.9% (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery duration (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142 (56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e150 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.309\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical approach (open)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.3% (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (130)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood transfusion (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2% (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative event (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.6% (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.4% (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStoma (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0% (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.4% (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdditional organ resection (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.4% (117)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.2% (72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.559\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperglycemia (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.8% (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.4% (49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypothermia (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.4% (301)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.3% (170)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect antibiotic prophylaxis (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.735\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVasopressors (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.0% (335)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.5% (200)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidural (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.7% (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8% (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eCategorical variables are expressed as proportions (%) and continuous variables as medians (interquartile range). P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePreoperative correction of anemia\u003c/h2\u003e \u003cp\u003eFollowing the diagnosis of anemia, 77.4% (n\u0026thinsp;=\u0026thinsp;192) of patients were treated according to the enhanced care bundle. Among these, 87.9% (n\u0026thinsp;=\u0026thinsp;167) received intravenous iron transfusions, while 12.1% (n\u0026thinsp;=\u0026thinsp;23) were given oral iron suppletion in the weeks leading up to surgery. In the treatment group, hemoglobin levels decreased in 4.2% (n\u0026thinsp;=\u0026thinsp;13) of patients, remained unchanged in 45.8% (n\u0026thinsp;=\u0026thinsp;143), and increased in 50.0% (n\u0026thinsp;=\u0026thinsp;156). The mean hemoglobin level during creation of the anastomosis was 8.2 mmol/L (13.2 g/dL). Perioperative anemia was observed in 32.3% (n\u0026thinsp;=\u0026thinsp;290) of the patients. A severe preoperative anemia was present in 6.2% (n\u0026thinsp;=\u0026thinsp;18) of the patients, mild in 37.6% (n\u0026thinsp;=\u0026thinsp;109), and minor in 56.2% (n\u0026thinsp;=\u0026thinsp;163), which was significantly different from preoperative measurements (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Preoperative anemia correction\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eBlood measurements\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePreoperative\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePerioperative\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ep value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.9 (3.1\u0026ndash;11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.2 (4.2\u0026ndash;12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.0% (315)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.3% (290)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere (\u0026lt;\u0026thinsp;6 mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.5% (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2% (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild (6\u0026ndash;7 mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.2% (111)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.6% (109)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinor (\u0026gt;\u0026thinsp;7 mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.2% (111)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.2% (163)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCorrection of preoperative anemia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom anemic to non-anemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.4% (73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange in hemoglobin level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnchanged (-0.5-0.5 mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.8% (143)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeclined (\u0026gt;\u0026thinsp;0.5 mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.2% (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased (\u0026gt;\u0026thinsp;0.5 mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.0% (156)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eCategorical variables are expressed as proportions (%) and continuous variables as medians (range). P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e outlines the differences between the preoperative iron treatment group and non-treatment group. Age, sex and comorbidities were not significantly different between the two groups. Patients who received preoperative anemia correction underwent significantly different surgical procedures (p\u0026thinsp;=\u0026thinsp;0.041) compared to those who did not receive iron treatment. Moreover, in the treatment group, exposure to hypothermia (66.1% vs. 50.5%, p\u0026thinsp;=\u0026thinsp;0.040) was significantly lower, while the administration of vasopressive drugs (48.2% vs. 72.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was significantly more frequent.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Baseline characteristics: preoperative correction anemia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNot corrected (n\u0026thinsp;=\u0026thinsp;56)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCorrected (n\u0026thinsp;=\u0026thinsp;192)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ep value\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.4% (31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.4% (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA-score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.4 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.6 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.7% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.5% (41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathology (malign)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86.8% (46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.8% (165)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant therapy (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.0% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5% (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntoxications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoker (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4% (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;14 packyears (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.9% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.7% (35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.1% (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.7% (91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.940\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;4 unites per day (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.3% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrugs (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerioperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight-sided hemicolectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.2% (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.5% (122)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtended right-sided hemicolectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.2% (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleocoecal resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransversum resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.4% (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6% (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft-sided hemicolectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.3% (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAR/TME\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.9% (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.8% (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaTME\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigmoidectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.6% (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.9% (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery duration (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150 (79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147 (63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical approach (open)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (130)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood transfusion (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.1% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.1% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative event (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.1% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.8% (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStoma (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.7% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdditional organ resection (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.8% (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.6% (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperglycemia (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.9% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.5% (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypothermia (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.1% (37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.5% (96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect antibiotic prophylaxis (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVasopressors (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.2% (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.4% (139)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidural (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.1% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.1% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eCategorical variables are expressed as proportions (%) and continuous variables as medians (interquartile range). P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter correction of preoperative anemia, changes in hemoglobin levels were significantly associated with the duration of surgery (155 vs. 142 vs. 155 min, p\u0026thinsp;=\u0026thinsp;0.037) and administration of vasopresssive drugs (76.9% vs. 70.5% vs. 54.5%, p\u0026thinsp;=\u0026thinsp;0.010) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Baseline characteristics: hemoglobin change after correction\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eUnchanged\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(n\u0026thinsp;=\u0026thinsp;143)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDeclined\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(n\u0026thinsp;=\u0026thinsp;13)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eIncreased\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(n\u0026thinsp;=\u0026thinsp;156)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ep value\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.1% (76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.9% (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.7% (76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA-score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.798\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.4 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.8 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.4 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.703\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.3% (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.2% (32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathology (malign)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.3% (113)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.8% (135)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant therapy (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.6% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.3% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8% (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntoxications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoker (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.3% (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.1% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;14 packyears (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.1% (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.0% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.6% (26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.5% (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.7% (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.0% (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;4 unites per day (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.918\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrugs (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerioperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight-sided hemicolectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.2% (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.5% (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.2% (97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtended right-sided hemicolectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.2% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1% (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleocoecal resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5% (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransversum resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.9% (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft-sided hemicolectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.5% (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1% (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAR/TME\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.7% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.1% (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaTME\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigmoidectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.7% (31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.7% (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9% (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery duration (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155 (99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142 (57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical approach (open)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (130)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood transfusion (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.2% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9% (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.370\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative event (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.5% (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStoma (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.8% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1% (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdditional organ resection (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.6% (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.2% (36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperglycemia (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.9% (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.6% (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.956\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypothermia (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.1% (86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.8% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.6% (78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect antibiotic prophylaxis (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1% (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVasopressors (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.5% (78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.9% (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.5% (110)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidural (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.3% (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2% (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eCategorical variables are expressed as proportions (%) and continuous variables as medians (interquartile range). P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSecondary outcomes\u003c/h2\u003e \u003cp\u003eCAL was observed in 6.1% (n\u0026thinsp;=\u0026thinsp;53) of the patients. The severity of CAL was classified as ISREC Grade A in 0%, Grade B in 9.4% (n\u0026thinsp;=\u0026thinsp;5) and Grade C in 90.6% (n\u0026thinsp;=\u0026thinsp;48). The incidence of CAL was not significantly associated with the correction of preoperative anemia (p\u0026thinsp;=\u0026thinsp;0.607) or with changes in hemoglobin levels after iron treatment (p\u0026thinsp;=\u0026thinsp;0.736). Moreover, there was no significant relationship between the severity of CAL and preoperative correction or changes in hemoglobin levels (p\u0026thinsp;=\u0026thinsp;0.318 and p\u0026thinsp;=\u0026thinsp;0.192 respectively).\u003c/p\u003e \u003cp\u003eThe postoperative course is summarized in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. The median length of stay was 4 days, which did not differ between patients with corrected and non-correction preoperative anemia (p\u0026thinsp;=\u0026thinsp;0.975) or changes in hemoglobin levels after iron treatment (p\u0026thinsp;=\u0026thinsp;0.325). The incidence and severity of other postoperative complications did not differ significantly between the corrected and non-corrected group (p\u0026thinsp;=\u0026thinsp;0.494 and p\u0026thinsp;=\u0026thinsp;0.235 respectively). Furthermore, changes in hemoglobin levels after correction were not associated with the occurrence or severity of postoperative complications (p\u0026thinsp;=\u0026thinsp;0.776 and p\u0026thinsp;=\u0026thinsp;0.548 respectively). Intensive care unit stay (p\u0026thinsp;=\u0026thinsp;0.058) and hospital readmissions (p\u0026thinsp;=\u0026thinsp;0.488) also showed no significant differences between the corrected and non-corrected groups, nor were they related to in hemoglobin levels after iron treatment (p\u0026thinsp;=\u0026thinsp;0.177 and p\u0026thinsp;=\u0026thinsp;0.521 respectively). The mortality rate was 0.8% (n\u0026thinsp;=\u0026thinsp;7) and was not significantly different between the corrected and non-corrected groups or changes in hemoglobin levels after iron treatment (p\u0026thinsp;=\u0026thinsp;0.541 and p\u0026thinsp;=\u0026thinsp;0.838 respectively).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Postoperative course\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eCorrection of preoperative anemia\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNot corrected (n\u0026thinsp;=\u0026thinsp;56)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCorrected (n\u0026thinsp;=\u0026thinsp;192)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ep value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAL (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.6% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5.3% (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e50.0% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10.0% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e50.0% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e90.0% (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther complications (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e23.2% (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e19.0% (36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e30.7% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e24.9% (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e38.5% (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e47.2% (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IIIa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e15.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5.6% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IIIb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e13.9% (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IVa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7.7% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IVb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2.8% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7.7% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5.6% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntensive care admission (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e12.5% (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4.7% (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRe-admission (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7.3% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10.4% (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.488\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.8% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.1% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.541\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDifferences in hemoglobin level after correction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eUnchanged\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(n\u0026thinsp;=\u0026thinsp;143)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDeclined\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(n\u0026thinsp;=\u0026thinsp;13)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eIncreased\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(n\u0026thinsp;=\u0026thinsp;156)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ep value\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAL (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.3% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.5% (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.736\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.3% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.7% (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e100% (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther complications (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.4% (29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e15.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e17.5% (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.0% (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e33.4% (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.1% (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e50.0% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e44.4% (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IIIa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.3% (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IIIb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.3% (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IVa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e50.0% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IVb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.4% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.9% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntensive care admission (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.1% (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7.7% (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.8% (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRe-admission (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.2% (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e8.3% (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.521\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.4% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.3% (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.838\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eCategorical variables are expressed as proportions (%) and continuous variables as medians (interquartile range). P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003cp\u003eAlterations in the hemoglobin levels were classified as declined when levels dropped\u0026thinsp;\u0026gt;\u0026thinsp;0.5 mmol/L, increased when elevated\u0026thinsp;\u0026gt;\u0026thinsp;0.5 mmol/L and unchanged between \u0026minus;\u0026thinsp;0.5 and 0.5 mmol/L.\u003c/p\u003e \u003cp\u003eCAL gradation according to ISREC; other complications gradation according to CD.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrated a reduction in the incidence and severity of perioperative anemia following the introduction of an enhanced care bundle. The enhanced care bundle facilitated early and consistent detection and treatment of preoperative anemia in patients undergoing elective colorectal surgery. In recent years, the significant impact of preoperative anemia on postoperative complications has become increasingly evident. As a result, anemia management has gained prominence in prehabilitation and other preoperative optimization care bundles aimed at reducing overall morbidity. However, this approach had not previously been consistently integrated into colorectal care pathways and The DoubleCheck study was the first to achieve this in a prospective multicenter trial [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This prospective sub-analysis of the DoubleCheck study provided valuable insights into the role of preoperative anemia correction on perioperative and postoperative outcomes.\u003c/p\u003e \u003cp\u003eOur findings revealed a significant association between perioperative hyperglycemia and preoperative anemia (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This observation may be partially explained by the higher prevalence of diabetes mellitus in patients with preoperative anemia (7.8% vs. 16.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, the association remained significant in the subgroup analysis of the patients without diagnosed diabetes (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). The relationship between anemia and hyperglycemia has been established previously, with proposed explanations suggesting that low hemoglobin levels are linked to an impaired glucose hemostasis and poor glycemic control [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Moreover, both type 1 and type 2 diabetes mellitus are known to exacerbate anemia. These interrelated factors underline the importance of simultaneously optimizing all risk factors for CAL.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Subgroup analysis perioperative hyperglycemia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eNo diabetes mellitus\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAnemia\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNo anemia\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAnemia\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNo anemia\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperglycemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.4% (26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0% (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHyperglycemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.4% (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.0% (19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo hyperglycemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.6% (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0% (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo hyperglycemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90.6% (213)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96.0% (459)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eVariables are expressed as proportions (%). P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis study did not demonstrate a significant association between the correction of preoperative anemia and postoperative complications, nor with changes in hemoglobin levels following anemia correction. This outcome may be attributed to the study\u0026rsquo;s focus on the effect of anemia correction alone, despite the fact that the overall intervention encompassed six distinct sub-interventions. The preventive impact of each individual sub-intervention on postoperative complications may be too subtle to detect when examined individually. Furthermore, optimizing multiple factors simultaneously may have a synergistic effect on the enhancement of the patient\u0026rsquo;s perioperative condition. Both outcomes indicate that anemia may be more accurately regarded as an indicator of overall poor physiological fitness rather than as an isolated risk factor.\u003c/p\u003e \u003cp\u003eThe definition of anemia and the established hemoglobin cut-off value remain a topic of ongoing debate. According to the World Health Organization, anemia is defined as \u0026ldquo;a condition in which the number of red blood cells or the hemoglobin concentration within them is lower than normal (\u0026lt;\u0026thinsp;13.0 g/dL in male, \u0026lt;\u0026thinsp;12.0 g/dL in female)\u0026rdquo; [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Commonly used cut-off values for hemoglobin levels vary between 7.0 and 8.5 mmol/L, with some studies employing gender-specific thresholds. For instance, Beutler et al. (2006) identified hemoglobin cut-off levels of 8.5 mmol/L (13.7 g/dL) in males and 7.6 mmol/L (12.2 g/dL) in females in a comprehensive literature review [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, more recent studies suggested a lower cut-off value of 7.4 mmol/L (12.0 g/dL), while others propose optimal cut-off values of 8.4 mmol/L (13.5 g/dL) in males and 7.4 mmol/L (12.0 g/dL) in females [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This lack of uniformity in cut-off values seems to depend on the specific investigated study population. Nevertheless, it is generally agreed that the cut-off values should differ for males and females, with males having higher thresholds, typically within the range of 7.5 and 8.5 mmol/L.\u003c/p\u003e \u003cp\u003eFurthermore, although intravenous iron transfusion in generally found to be more effective than oral supplementation, practice variations still frequently occur in daily practice [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This variation may be attributable to the difference in costs, with intravenous transfusions being approximately six times more expensive compared to oral supplementation [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Given the limited time between diagnosis and surgery, oral iron suppletion may not elevate hemoglobin levels rapidly enough, leading to preference for intravenous administration. In addition, colorectal cancer is associated with alterations in iron absorption, which can impair the efficacy of oral iron supplements [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Therefore, intravenous iron supplementation is particularly advantageous for oncological patients, who have a higher prevalence of preoperative anemia (81.9% vs. 90.7%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). While the difference between intravenous and oral iron treatment has been less thoroughly studied in patients with benign surgical indications, intravenous iron transfusions also appear to be the preferable option in this subgroup [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA strength of this study is its international, multicenter and prospective design. Additionally, the proposed approach for anemia detection and correction involved widely accessible, simple, and cost-effective interventions, making it feasible for global implementation in colorectal care pathways. However, the study had some limitations, including the potential confounding effects of other safety procedures aimed at reducing postoperative complications. Nonetheless, we believe these factors had minimal impact on hemoglobin levels and the availability of optimization resources.\u003c/p\u003e \u003cp\u003eIn conclusion, the study demonstrated that early detection and correction of preoperative anemia is achievable with the implementation of the DoubleCheck enhanced care bundle. Preoperative anemia may be more indicative of overall poor physiological fitness rather than an isolated factor. Implementation of early and consistent preoperative anemia detection and correction will enhance the quality of care for patients undergoing elective colorectal surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eFD received an educational grant from Medtronic. Medtronic had no role in the study design, data collection, data analysis, data interpretation or writing of the manuscript. All other authors declare no conflict of interests.\u003c/p\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethical Committee of the Vrije Universiteit and the eight participating hospitals (16-03-2021; 2020.0634), and declared exempt from the Medical Research Involving Human Subjects Act (WMO).\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was funded by Medtronic.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAdW, BTB, DEH, GK and FD were involved in study conceptualization and design. All stated authors and contributors were involved in data acquisition and had full access to all study data. AdW and FD verified the data, did the analysis and interpretation of this data and wrote the original manuscript draft. FD and GK provided supervision during all phases of this study. All authors revised the manuscript critically for important intellectual content and provided final approval of the version to be published.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe Taskforce Anastomotic Leakage is part of the Dutch Society of Colorectal Surgery and consists of drs. Anne de Wit (Amsterdam UMC), drs. Boukje T. Bootsma (Amsterdam UMC), drs. Daitlin E. Huisman (Amsterdam UMC), dr. Bob van Wely (Bernhoven), dr. Julie van Hoogstraten (Bernhoven), dr. Dirk J.A. Sonneveld (Dijklander), dr. Daan Moes (Dijklander), dr. Johannes A. Wegdam (Elkerliek), prof. dr. Carlo V. Feo (Ferrara), dr. Emiel G.G. Verdaasdonk (Jeroen Bosch), dr. Walter J.A. Brokelman (Jeroen Bosch), drs. David W.G. ten Cate (Maxima MC), dr. Tim Lubbers (Maastricht UMC+), dr. Emmanuel Lagae (ZorgSaam), dr. David J.G.H. Roks (ZorgSaam), prof. dr. Geert Kazemier (Amsterdam UMC), dr. Jurre Stens (Leeuwarden MC), dr. Gerrit D. Slooter (Maxima MC) and dr. Freek Daams (Amsterdam UMC). Medtronic awarded an educational grant to FD, which was used to hire multiple junior researchers over several years. Part of their activities was executing the DoubleCheck study. Medtronic had no role in study design, data collection, data analysis, data interpretation or writing of the manuscript. All authors take full responsibility for the integrity and completeness of the content of this manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eDe-identified individual participant data collected in this study and additional relevant related documents can be made available upon request by contacting AdW ([email protected]) or FD ([email protected]). There are no date restrictions on the availability of the data. The investigators will be allowed to approve all research conducted with the shared data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZarnescu, E. C., Zarnescu, N. O., \u0026amp; Costea, R. (2021). Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery. Diagnostics, 11(12), 2382. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/diagnostics11122382\u003c/span\u003e\u003cspan address=\"10.3390/diagnostics11122382\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSparreboom, C. L., Van Groningen, J. T., Lingsma, H. F., Wouters, M. W., Menon, A. G., Kleinrensink, G., Jeekel, J., \u0026amp; Lange, J. F. (2018). Different Risk Factors for Early and Late Colorectal Anastomotic Leakage in a Nationwide Audit. 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Anemia, 2015, 1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1155/2015/354737\u003c/span\u003e\u003cspan address=\"10.1155/2015/354737\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"techniques-in-coloproctology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tcol","sideBox":"Learn more about [Techniques in Coloproctology](http://link.springer.com/journal/10151)","snPcode":"10151","submissionUrl":"https://submission.nature.com/new-submission/10151/3","title":"Techniques in Coloproctology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"anemia, iron transfusion, colorectal surgery, anastomotic leakage","lastPublishedDoi":"10.21203/rs.3.rs-5331736/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5331736/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003ePreoperative anemia is an important target in preventing colorectal anastomotic leakage (CAL). However, it is not consistently detected and corrected in patients undergoing colorectal surgery. This study aimed to evaluate the impact of early detection and correction of preoperative anemia on perioperative outcomes and CAL.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e This was a prospective sub-analysis of the DoubleCheck study, an international open-labelled trial which implemented an enhanced care bundle to prevent CAL after elective colorectal surgeries. It introduced interventions for early detection and correction of preoperative anemia. Primary outcome was the incidence of preoperative anemia and the effect of early correction. Secondary outcomes included the impact on CAL, postoperative course, and mortality.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study included 899 patients across eight European hospitals (September 2021 - December 2023). Preoperative anemia was identified in 35.0% (n\u0026thinsp;=\u0026thinsp;315) of participants, with 77.4% (n\u0026thinsp;=\u0026thinsp;192) receiving iron therapy. Hemoglobin levels decreased in 4.2% (n\u0026thinsp;=\u0026thinsp;13), remained stable in 45.8% (n\u0026thinsp;=\u0026thinsp;143), and increased in 50.0% (n\u0026thinsp;=\u0026thinsp;156) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Perioperative hyperglycemia was more common among anemic patients (7.8% vs. 16.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). CAL occurred in 6.1% (n\u0026thinsp;=\u0026thinsp;53) of the patients. Anemia correction and changes in hemoglobin levels after iron treatment were not significantly associated with CAL, other complications, or mortality.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study demonstrated that anemia indicates overall poor physiological fitness rather than being an isolated risk factor. Early detection and correction of preoperative anemia is achievable and improves quality of care for elective colorectal surgery patients.\u003c/p\u003e\u003ch2\u003eTrial number\u003c/h2\u003e \u003cp\u003eNCT05250882 (20-01-2022)\u003c/p\u003e","manuscriptTitle":"Early detection and correction of preoperative anemia in patients undergoing colorectal surgery – a prospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-06 11:16:15","doi":"10.21203/rs.3.rs-5331736/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-20T20:31:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-29T15:40:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88993842246011725200467154768049182953","date":"2024-11-26T13:55:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-08T08:37:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-07T12:48:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-26T02:49:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"Techniques in Coloproctology","date":"2024-10-25T10:36:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"techniques-in-coloproctology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tcol","sideBox":"Learn more about [Techniques in Coloproctology](http://link.springer.com/journal/10151)","snPcode":"10151","submissionUrl":"https://submission.nature.com/new-submission/10151/3","title":"Techniques in Coloproctology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"f67c6292-5a4a-463b-b976-07c10102d726","owner":[],"postedDate":"November 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-07T15:59:20+00:00","versionOfRecord":{"articleIdentity":"rs-5331736","link":"https://doi.org/10.1007/s10151-025-03131-5","journal":{"identity":"techniques-in-coloproctology","isVorOnly":false,"title":"Techniques in Coloproctology"},"publishedOn":"2025-04-05 15:56:56","publishedOnDateReadable":"April 5th, 2025"},"versionCreatedAt":"2024-11-06 11:16:15","video":"","vorDoi":"10.1007/s10151-025-03131-5","vorDoiUrl":"https://doi.org/10.1007/s10151-025-03131-5","workflowStages":[]},"version":"v1","identity":"rs-5331736","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5331736","identity":"rs-5331736","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}