Baseline audit of iron deficiency anaemia in elective cardiac surgery and the introduction of a new multidisciplinary management pathway

ABSTRACT

UK guidelines have recommended preoperative screening and treatment of anaemia in major surgery since 2015.1 We audited rates of anaemia in elective cardiac surgery in our centre and developed a pathway to manage these patients. Iron deficiency anaemia, in cardiac surgical patients in the UK, has a prevalence of between 23% and 45%. Although still debated, there is evidence efficient treatment may decrease transfusion requirement and risk, perioperative morbidity and mortality, and shorten ICU and hospital stays.2 We retrospectively reviewed notes from 100 patients undergoing elective primary coronary artery bypass grafting, valve replacement surgery, or both between August 22, 2019 and February 11, 2020. Twelve patients had to be excluded as a result of misclassification. Using electronic records we reviewed blood results at the time of booking and on the day of surgery and audited if treatment for iron deficiency had been offered. At booking, 28.4% (25/88) of our sample were anaemic (haemoglobin <130 male, <120 female). The average time between booking and surgery was 84 days. Of the 25 anaemic patients, four had iron studies performed and one patient received iron therapy. On the day of surgery, 44 patients had blood tests repeated;47.7% were anaemic. Eight patients who were anaemic at booking had no repeat blood tests and were likely still anaemic. Nine patients had become anaemic since booking and 11 of the 25 anaemic patients had lower haemoglobin levels. Given the low rate of repeat blood tests, the real number of patients anaemic on the day of surgery is likely to be higher (∼47.7–65.9%). Given the prevalence of anaemia in our sample population, the long period from booking to surgery, and the surprising increase in anaemia on the day of surgery, we developed a new management algorithm. All cardiac patients now have iron studies at the time of listing and treatment is initiated as per the algorithm (Fig. 6) if they are iron deficient. This work is currently being extended to all of our elective patients undergoing major surgery. Unfortunately, our surgical service has been severely disrupted by COVID-19, decreasing our elective workload and thus delaying re-audit to assess the efficacy of our interventions at this time. References 1. National Institute for Health and Care Excellence (2015). Available from (accessed January 2020) 2. Klein AA, Collier TJ, Brar MS, et al. Anaesthesia 2016;71 627–35 [Formula presented]