Background: Approximately one in three patients suffers from preoperative anaemia. Even though haemoglobin is measured before surgery, anaemia management is not implemented in every hospital. Objective: Here, we demonstrate the implementation of an anaemia walk-in clinic at an Orthopedic University Hospital. To improve the diagnosis of iron deficiency (ID), we examined whether reticulocyte haemoglobin (Ret-He) could be a useful additional parameter. Material and Methods: In August 2019, an anaemia walk-in clinic was established. Between September and December 2019, major orthopaedic surgical patients were screened for preoperative anaemia. The primary endpoint was the incidence of preoperative anaemia. Secondary endpoints included Ret-He level, red blood cell (RBC) transfusion rate, in-hospital length of stay and anaemia at hospital discharge. Results: A total of 104 patients were screened for anaemia. Preoperative anaemia rate was 20.6%. Intravenous iron was supplemented in 23 patients. Transfusion of RBC units per patient (1.7 ± 1.2 vs. 0.2 ± 0.9; p = 0.004) and hospital length of stay (13.1 ± 4.8 days vs. 10.6 ± 5.1 days; p = 0.068) was increased in anaemic patients compared to nonanaemic patients. Ret-He values were significantly lower in patients with ID anaemia (33.3 pg [28.6-40.2 pg]) compared to patients with ID (35.3 pg [28.9-38.6 pg]; p = 0.015) or patients without anaemia (35.4 pg [30.2-39.4 pg]; p = 0.001). Conclusion: Preoperative anaemia is common in orthopaedic patients. Our results proved the feasibility of an anaemia walk-in clinic to manage preoperative anaemia. Furthermore, our analysis supports the use of Ret-He as an additional parameter for the diagnosis of ID in surgical patients. K E Y W O R D S anaemia walk-in clinic, blood transfusion, iron deficiency, orthopaedic patients, patient blood management, reticulocyte haemoglobin Patrick Meybohm and Andrea Meurer contributed equally to this study.

Regional anesthesia is currently the predominant method of choice for post-operative acute pain management. Neuraxial blockage is especially important when considering all spinal procedures.

Over the last few years bone resin based vertebral augmentation in the form of vertebro- and kyphoplasty has proved to be a safe therapeutic option in cases of vertebral compression fractures. Nevertheless, rare systemic complications have been seen, i.e., pulmonary embolisms ranging from harmless to lethal.The presence of an anesthesiologist can be especially useful in cases of systemic complications. Whether the form of anesthesia has any influence on the outcome of vertebro- or kyphoplasty is currently unknown. Local anesthesia supplemented by analgosedation is often used as an alternative to general anesthesia. The rationale for one or the other form of anesthesia can be factors like type of augmentation (vertebro- or kyphoplasty), number of vertebral levels to be treated as well as the patient's age, condition, and comorbidities.Single-shot epidural anesthesia is yet another anesthetic option that has been successfully used in our clinic for some years now. It combines the advantages of general and local anesthesia: excellent segmental analgesia even in multilevel cases in awake and responding patients.