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Preoperative Anemia Screening and Treatment Practices in Patients Having Total Joint Replacement Surgery: A
Alana Delaforce1,2, Lemya Galeel2, Edgar Poon3
1School of Nursing, University of Newcastle, Newcastle, NSW, Australia.
Insights
Preoperative anemia in surgical patients increases transfusion risk and hospital stay. Early screening and treatment are crucial for patient blood management and improved surgical outcomes.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Hematology
- Health Services Research
Background:
- Preoperative anemia is linked to adverse surgical outcomes.
- Patient Blood Management (PBM) guidelines advocate for preoperative anemia screening and treatment.
- Optimizing patients before surgery is essential for reducing risks.
Purpose of the Study:
- To assess compliance with PBM guidelines for preoperative anemia management.
- To determine the association between preoperative anemia and transfusion risk.
- To investigate the relationship between preoperative anemia and hospital length of stay.
Main Methods:
- Retrospective, observational chart audit.
- Included patients undergoing primary total hip and knee replacement.
- Data collected from July-December 2018 at a tertiary metropolitan healthcare facility.
Main Results:
- 14.6% of patients had preoperative anemia; only 5.9% received treatment.
- Anemic patients were significantly more likely to receive blood transfusions (OR 8.65).
- Preoperative anemia was associated with a longer hospital stay (median difference = 1 day).
Conclusions:
- Comprehensive preoperative testing (including iron studies) is recommended for anemia detection.
- Screening timing must allow for patient optimization.
- Appropriate anemia treatment can reduce transfusions and length of stay.
- A standardized preoperative anemia pathway could improve clinical practice.
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, χ2 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.
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