<p>Preoperative Anemia Screening and Treatment Practices in Patients Having Total Joint Replacement Surgery: A Retrospective, Observational Audit</p>

Abstract

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: 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: 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 2 LR = 17.2, df=1, p<0.007). Conclusion: 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.

A Theoretically Informed Approach to Support the Implementation of Pre-Operative Anemia and Iron Deficiency Screening, Evaluation, and Management Pathways: Protocol for a Type Two Hybrid-Effectiveness Study

“…Assuming a baseline (pre-implementation) level of compliance of 5% during sample size calculations, 400 patients (200 pre and 200 post implementation) are needed to detect a 20% absolute improvement in compliance (ie, Post-stage compliance of 25%). 31 , 32 Data will be described using means and standard deviations, for continuous variables, and counts and percentages, for categorical data. Statistical analysis for the patient outcomes (proportion of patients anemic on the day of surgery, and proportion of patients who receive a blood transfusion during the peri-operative period) will involve using binary logistic regression.…”

Perioperative Quality Initiative and Enhanced Recovery After Surgery-Cardiac Society Consensus Statement on the Management of Preoperative Anemia and Iron Deficiency in Adult Cardiac Surgery Patients

“…Many patients do not have routine laboratory studies until a day or 2 before surgery, and even when a patient is identified as having anemia, further testing and diagnosis of cause are incomplete. 60 To avoid missing the opportunity to evaluate anemia once recognized, it is possible to draw all necessary laboratory studies at the time of initial anemia screening, and only run the additional tests if and when anemia is identified, through leveraging the electronic medical record (EMR). 61 The EMR can also be used to prompt for anemia evaluation as soon as surgery is scheduled, and in institutions that have it, we recommend leveraging the EMR to provide alerts to clinicians to identify patients who are anemic before surgery and prompt further evaluation.…”

Patients’ Choice, Consent, and Ethics in Patient Blood Management

“…46 The concept of managing and preserving the patient's own blood is not only empowering for patients but is also evidenced-based management that reduces the risk of receiving a blood transfusion. 9,38,[47][48][49][50] Effectively implemented PBM programs tick all the boxes of evidence, quality, safety, cost-effectiveness, and ethics, and ensure blood advocacy for patients while implementing pathways and tools that aim for optimal clinical outcomes. 51…”