Preoperative Anemia Screening and Treatment Practices in Patients Having Total Joint Replacement Surgery: A Retrospective, Observational Audit.
patient blood management
preoperative anemia
surgery
Journal
Journal of blood medicine
ISSN: 1179-2736
Titre abrégé: J Blood Med
Pays: New Zealand
ID NLM: 101550884
Informations de publication
Date de publication:
2020
2020
Historique:
received:
19
03
2020
accepted:
29
06
2020
entrez:
22
8
2020
pubmed:
22
8
2020
medline:
22
8
2020
Statut:
epublish
Résumé
Surgical patients with preoperative anemia are more likely to experience adverse outcomes. Patient blood management (PBM) guidelines recommend screening and treating patients for anemia preoperatively to enable optimisation before surgery. This study investigates compliance with PBM guidelines and reports the association between length of stay and transfusion risk in patients with preoperative anemia. A retrospective, observational, chart audit that included all patients having primary, total hip and knee replacement surgery between July-December 2018 at a tertiary, metropolitan healthcare facility. Six hundred and seven patients patients were included, 96% (n = 583) patients had blood tests available (full blood count), and 8.1% (n = 49) had iron studies. Most patients 53% (n = 324) were screened between 2 and 6 days before surgery; 14.6% (n = 85) were anaemic preoperatively and only 5.9% (n = 5) of anaemic patients received treatment. Patients who had anemia preoperatively were more likely to receive a blood transfusion (odds ratio 8.65 [95% CI 3.98-18.76]) and stayed longer in hospital (median difference = 1, χ Tests ordered for patients having major surgery should include iron studies, renal function, CRP and full blood count to enable detection and classification of preoperative anemia. Timing of screening relative to surgery needs to be sufficient to allow patient optimisation to occur. Appropriate treatment should be provided to anaemic patients to prevent unnecessary blood transfusions and reduce the length of stay. A standardised preoperative anemia pathway may assist in improving practice.
Sections du résumé
BACKGROUND
BACKGROUND
Surgical patients with preoperative anemia are more likely to experience adverse outcomes. Patient blood management (PBM) guidelines recommend screening and treating patients for anemia preoperatively to enable optimisation before surgery. This study investigates compliance with PBM guidelines and reports the association between length of stay and transfusion risk in patients with preoperative anemia.
STUDY DESIGN AND METHODS
METHODS
A retrospective, observational, chart audit that included all patients having primary, total hip and knee replacement surgery between July-December 2018 at a tertiary, metropolitan healthcare facility.
RESULTS
RESULTS
Six hundred and seven patients patients were included, 96% (n = 583) patients had blood tests available (full blood count), and 8.1% (n = 49) had iron studies. Most patients 53% (n = 324) were screened between 2 and 6 days before surgery; 14.6% (n = 85) were anaemic preoperatively and only 5.9% (n = 5) of anaemic patients received treatment. Patients who had anemia preoperatively were more likely to receive a blood transfusion (odds ratio 8.65 [95% CI 3.98-18.76]) and stayed longer in hospital (median difference = 1, χ
CONCLUSION
CONCLUSIONS
Tests ordered for patients having major surgery should include iron studies, renal function, CRP and full blood count to enable detection and classification of preoperative anemia. Timing of screening relative to surgery needs to be sufficient to allow patient optimisation to occur. Appropriate treatment should be provided to anaemic patients to prevent unnecessary blood transfusions and reduce the length of stay. A standardised preoperative anemia pathway may assist in improving practice.
Identifiants
pubmed: 32821186
doi: 10.2147/JBM.S254116
pii: 254116
pmc: PMC7418168
doi:
Types de publication
Journal Article
Langues
eng
Pagination
259-265Informations de copyright
© 2020 Delaforce et al.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest for this work.
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