Postoperative anaemia and the need for effective patient blood management (PBM) are major concerns in elective orthopaedic surgery - a multicentre observational study (PREPARE)

Lasocki, Sigismond; Krauspe, R.; Mezzacasa, Anna; Heymann, Christian von; Spahn, Donat R.

doi:10.1097/00003643-201206001-00318

Cited by 64 publications

(111 citation statements)

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“…There is strong evidence that preoperative anaemia and ABT are independent, and that they represent additive risk factors for increased LOS as well as poor postoperative outcome, increased morbidity (including infection) and mortality. [17][18][19][20] Somewhat surprisingly, these issues have received relatively little attention and to our knowledge, there is only one previous report of a preoperative blood management programme from the UK in the surgical literature. 21 The results of this study were presented in part at the British Hip Society meeting held in London in March 2015.…”

Section: Discussionmentioning

confidence: 99%

Impact of a blood management protocol on transfusion rates and outcomes following total hip and knee arthroplasty

Frew

Alexander

Hood

et al. 2016

annals

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INTRODUCTION Preoperative anaemia remains undertreated in the UK despite advice from national agencies to implement blood conservation measures. A local retrospective audit of 717 primary hip/knee replacements in 2008-2009 revealed 25% of patients were anaemic preoperatively. These patients experienced significantly increased transfusion requirements and length of stay. We report the results of a simple and pragmatic blood management protocol in a district general hospital. METHODS Since 2010 patients at our institution who are found to be anaemic when listed for hip/knee replacement have been offered iron supplementation and/or erythropoietin depending on haemoglobin and ferritin levels. In this study, postoperative blood transfusions, length of stay and readmissions were assessed retrospectively for all patients undergoing elective primary hip/knee replacement in 2014 and compared with the baseline findings. RESULTS During the 12-month study period, 406 patients were eligible for inclusion and none were excluded. Eighty-nine patients (22%) were anaemic preoperatively and sixty-five received treatment. The transfusion rate fell from the baseline levels of 23.0% and 6.7% to 4.3% and 0.5% for hip and knee replacements respectively (p<0.001). The median length of stay reduced from 6 to 3 days (p<0.001) for both hip and knee replacements. The rate for readmissions within 90 days fell from 13.5% to 8.9% (p<0.05). CONCLUSIONS Preoperative anaemia is common in patients listed for hip/knee replacement and it is associated strongly with increased blood transfusion. The introduction of a blood management protocol has led to significant reductions in transfusion and length of stay, sustained over a four-year period. This suggests that improved patient outcomes, conservation of blood stocks and cost savings can be achieved.

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Section: Discussionmentioning

confidence: 99%

Impact of a blood management protocol on transfusion rates and outcomes following total hip and knee arthroplasty

Frew

Alexander

Hood

et al. 2016

annals

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“…The benefits of PBM appear to be clear, particularly in surgery, to address the triad of independent risk factors that affect outcome in surgical patients: anaemia, blood loss and transfusion. Significant direct and indirect cost savings can be achieved in the surgical setting, and early data suggest that implementation of PBM strategies is associated with improved clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Patient blood management to reduce surgical risk

Clevenger

Mallett

Klein

et al. 2015

British Journal of Surgery

123

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Background: Preoperative anaemia and perioperative blood transfusion are both identifiable and preventable surgical risks. Patient blood management is a multimodal approach to address this issue. It focuses on three pillars of care: the detection and treatment of preoperative anaemia; the reduction of perioperative blood loss; and harnessing and optimizing the patient-specific physiological reserve of anaemia, including restrictive haemoglobin transfusion triggers. This article reviews why patient blood management is needed and strategies for its incorporation into surgical pathways.Methods: Studies investigating the three pillars of patient blood management were identified using PubMed, focusing on recent evidence-based guidance for perioperative management.Results: Anaemia is common in surgical practice. Both anaemia and blood transfusion are independently associated with adverse outcomes. Functional iron deficiency (iron restriction due to increased levels of hepcidin) is the most common cause of preoperative anaemia, and should be treated with intravenous iron. Intraoperative blood loss can be reduced with antifibrinolytic drugs such as tranexamic acid, and cell salvage should be used. A restrictive transfusion practice should be the standard of care after surgery. Conclusion:The significance of preoperative anaemia appears underappreciated, and its detection should lead to routine investigation and treatment before elective surgery. The risks of unnecessary blood transfusion are increasingly being recognized. Strategic adoption of patient blood management in surgical practice is recommended, and will reduce costs and improve outcomes in surgery.

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“…Our study shows that the introduction of a written PBM protocol for the entire perioperative period allows a decrease in perioperative transfusions and in postoperative moderate to severe anemia rate. The concept of PBM has been developed to reduce blood transfusion and perioperative anemia, which are both associated with increased morbidity and mortality . Our PBM protocol combines all the three pillars of PBM: optimization of hematopoiesis using EPO and IV iron, reduction of blood loss using tranexamic acid, and restrictive transfusion triggers.…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative anemia is common in major orthopedic surgery, concerning approximately 15% to 25% of patients in the preoperative period and as much as 80% of them in the postoperative period . Perioperative anemia is responsible for increased postoperative morbidity and mortality and was found to be an independent risk factor for death in several studies . In addition, perioperative anemia is also associated with increased transfusion rates, and transfusion is associated with increased morbidity and mortality …”

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confidence: 99%

Implementing a blood management protocol during the entire perioperative period allows a reduction in transfusion rate in major orthopedic surgery: a before–after study

et al. 2016

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Postoperative anaemia and the need for effective patient blood management (PBM) are major concerns in elective orthopaedic surgery - a multicentre observational study (PREPARE)

Cited by 64 publications

References 0 publications

Impact of a blood management protocol on transfusion rates and outcomes following total hip and knee arthroplasty

Impact of a blood management protocol on transfusion rates and outcomes following total hip and knee arthroplasty

Patient blood management to reduce surgical risk

Implementing a blood management protocol during the entire perioperative period allows a reduction in transfusion rate in major orthopedic surgery: a before–after study

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