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

Abstract

Alana Delaforce,1,2 Lemya Galeel,2 Edgar Poon,3 Cameron Hurst,4 Jed Duff,1,5 Judy Munday,5,6 Janet Hardy2 1School of Nursing, University of Newcastle, Newcastle, NSW, Australia; 2Mater Research, Mater Health Services, South Brisbane, QLD, Australia; 3School of Pharmacy, University of Queensland, Brisbane, Australia; 4QIMR Berghoffer Medical Research Institute, Brisbane, QLD, Australia; 5School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia; 6School of Nursing, The University of Agder, Kristiansand, NorwayCorrespondence: Alana DelaforceMater Research Mater Health Services, Level 6, Duncombe Building, Raymond Terrace, South Brisbane, QLD 4101, AustraliaTel [phone]Email [email protected]: 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.Keywords: preoperative anemia, patient blood management, surgery

Keywords

• preoperative anemia
• patient blood management
• surgery