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Improving Anemia and Curbing Transfusion in Gynaecologic Surgery (IMPACT-GS): Multidisciplinary and Multimodal
Innie Chen1, Karima Khamisa2, Aisling Clancy3
1Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON; Department of Obstetrics, Gynaecology and Newborn Care, The Ottawa Hospital, Ottawa, ON; The Ottawa Hospital Research Institute, Ottawa, ON; Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON.
Objectives:
To assess the effect of a multidisciplinary and multimodal intervention bundle on preoperative hematologic parameters and perioperative transfusion rates.
Methods:
A multidisciplinary and multimodal hemoglobin optimization intervention bundle was developed and implemented at a tertiary academic centre (April-June 2023) to include clinical care algorithms based on preoperative hemoglobin values, dedicated nursing interventions, electronic medical record reminders, patient educational material, and department-wide communication strategies with clinical teams. A retrospective analysis was conducted to assess the effect of this intervention bundle.
Results:
A total of 2026 hysterectomies were included (908 pre-intervention and 1118 after intervention). Following intervention, there was an increase in mean preoperative hemoglobin level (129.7 ± 15.4 g/L before intervention to 131.7 ± 14.1 g/L after intervention, P < 0.05). Overall, there was no significant difference in the proportions of preoperative anemia (Hb <120 g/L) between periods. There was a reduction in patients with preoperative hemoglobin values lower than 110 g/L (9.5% before intervention to 6.6% after intervention, P < 0.05) and 100 g/L (5.5% before intervention to 2.7% after intervention, P < 0.05). Following intervention, there was a decrease in perioperative transfusion rates (4.3% before intervention to 2.5% after intervention, P < 0.05), as well as postoperative transfusion rates (3.5% before intervention to 2.0% after intervention, P < 0.05). Compared with pre-intervention, there were decreased odds of preoperative Hb <110 g/L (OR 0.678; 95% CI 0.476-0.966), Hb <100 g/L (OR 0.486; 95% CI 0.295-0.802), receiving a perioperative (OR 0.572; 95% CI 0.349-0.938) and postoperative transfusion (OR 0.549; 95% CI 0.317-0.952).
Conclusions:
A multidisciplinary, multimodal approach to preoperative hemoglobin optimization can significantly reduce transfusion rates, thereby improving gynaecologic surgery outcomes.
