Patient Blood Management (PBM)
Areas of Expertise

Preoperative anaemia

Facts about preoperative anaemia

Prevalence of preoperative anaemia in Switzerland1

  • Preoperative anaemia is common; 25–45% in knee and hip surgery1
  • 90% of patients with preoperative anaemia are not treated prior to elective procedures which results in 3–4 × higher transfusion rates2

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Effects of preoperative anaemia on postoperative prognosis3, 4, 5, 6, 7, 8, 9

  • More frequent complications and delayed recovery10
  • Relative risk of mortality increases by 30–40% in mild anaemia, whereby the degree of anaemia directly correlates with the prognosis10, 11, 12

graph

Preoperative correction of anaemia and iron deficiency
  • Leads to faster mobilisation of patients and shorter stays in hospital9, 12, 13
  • Lowers costs14, 15
  • Possible anaemia should be investigated 30 days prior to the procedure and corrected as needed

For example:

  • In knee, hip or spine surgery, mean preoperative iron requirements in anaemic patients are 1000 mg10
  • These preoperative iron requirements of 1000 mg can be corrected in 15 minutes with
    1 dose of Ferinject®15

With preoperative correction of anaemia:

  • postoperative anaemia can be prevented10
  • the patient recovers faster9, 12, 13
  • the number and volume of blood transfusions can be reduced9, 12, 13

 

Prior to a procedure with a high likelihood of blood loss, it can also be advantageous to top up the body’s iron stores.

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References

  1. Spahn DR. Anemia and patient blood management in hip and knee surgery. Anesthesiology 2010; 113: 482–495.
  2. Gombotz H et al. Patient blood management (part 1) – patient-specific concept to reduce and avoid anemia, blood loss and transfusion. Anaesthesiol Intensivmed Notfallmed Schmerzther 2011; 46: 396–401.
  3. Beris P et al. Perioperative anemia management: consensus statement on the role of intravenous iron. Br J Anaesth 2008; 100: 599–604.
  4. Beattie WS et al. Risk associated with preoperative anemia in non-cardiac surgery: a single-center cohort study. Anesthesiology 2009; 110: 574–581.
  5. Dunne JR et al. Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery. J Surg Res 2002; 102: 237–244.
  6. Carson JL et al. Effect of anemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996; 348: 1055–1060.
  7. Gruson KI et al. The relationship between admission hemoglobin level and outcome after hip fracture. J Orthop Trauma 2002; 16: 39–44.
  8. Wu WC et al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing non-cardiac surgery. JAMA 2007; 297: 2481–2488.
  9. Mehra T, et al. Implementation of a patient blood management monitoring and feedback program significantly reduces transfusions and costs. Transfusion 2015; Dec;55(12):2807-15
  10. Theusinger OM et al. Patient blood management in orthopaedic surgery: a four-year follow-up of transfusion requirements and blood loss from 2008 to 2011 at the Balgrist University Hospital in Zurich, Switzerland. Blood Trans 2014; 12: 195–203.
  11. Musallam KM et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 2011; 378: 1396–1407.
  12. Kotze A, Carter LA, Scally AJ. Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle. Br J Anaesth 2012; 108: 943–952.
  13. Lawrence VA et al. Higher Hb level is associated with better early functional recovery after hip fracture repair. Transfusion 2003; 43: 1717–1722.
  14. Leahy MF et al. Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion. 2017; 57 (6): 1347–58.
  15. Mehra T et al. Implementation of a PBM monitoring and feedback program significantly reduces transfusions and costs. Transfusion. 2015; 55: 2807–2815.
Preoperative Anaemia | Ferinject CH
90% of patients with preoperative anaemia are not treated prior to elective procedures
which results in 3–4 X higher transfusion rates.