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

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, 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

Acknowledgments

The author AD gratefully acknowledges assistance received from the Australian Government Research Training Program Scholarship. We gratefully acknowledge the assistance with data collection provided by Dr Brittany Hulbert and assistance with consultation on the data collection forms and study design from Dr Treasure McGuire.

Disclosure

The authors report no conflicts of interest for this work.