ABSTRACT
Preoperative anemia is progressively being recognized as a risk factor for poor perioperative outcomes including increased length of hospital stay and increased blood transfusions. The growth in prevalence of preoperative anemia in patients undergoing gynecological oncology procedures warrants greater attention to early identification for optimal surgical outcomes. This was a quantitative retrospective observational study consisting of 284 patients undergoing gynecological oncology procedures. The study sought to determine the frequency of anemia, iron deficiency and the effect of anemia on the number of blood transfusions from January 1 to December 31, 2014. Patients with anemia had significantly higher transfusion rates (44% versus 11%, p < 0.0001), considerably higher number of units transfused per patient (mean 1.19 units versus 0.28 units, p < 0.0001) and longer length of stays post-operatively (mean 5.9 days versus 4.6 days, p=0.0008). It was concluded that early identification and treatment of anemia is a key opportunity to optimized surgical outcomes.
ABSTRACT
As the number of cancer cases rise each year in Canada, so does the number of surgical oncology cases. Surgery presents a unique and heightened stressor for the body already experiencing volatility from factors such as disease and treatments. Perioperative red blood cell (RBC) transfusions are critical to stabilize hemoglobin levels and correct anemia, as well as provide a buffer against anticipated intraoperative blood loss. Thoroughly examining and anticipating risk factors related to the potential need for perioperative blood transfusions is necessary to improve outcomes. Research evidence in recent years related to perioperative blood management of oncology patients has specifically recommended active, coordinated programs to reduce the need and amount of blood transfusions administered pre-, intra-, and post-surgery. Coordination between surgical oncologists and a local or provincial patient blood management (PBM) program is an important strategy that allows patients at risk of perioperative complications to be identified and receive early interventions and ongoing observation.
ABSTRACT
OBJECTIVE: Preoperative anemia management reduces red blood cell (RBC) transfusion and adverse outcomes, but how best to optimize the patient's hemoglobin (Hgb) before cardiac surgery remains unclear. The authors sought to determine the optimal treatment of anemia using iron and epoetin alfa before cardiac surgery. DESIGN: Retrospective cohort study. SETTING: Sunnybrook Health Sciences Centre, University of Toronto. PARTICIPANTS: The study comprised 532 consecutive patients referred to the outpatient Blood Conservation Clinic and who underwent cardiac surgery between 2008 and 2018. INTERVENTIONS: Of the 532 patients, 207 received oral iron, 84 received intravenous (IV) iron, 71 received epoetin alfa, 92 received combination therapy, and 78 received no treatment. MEASUREMENTS AND MAIN RESULTS: Multivariate linear, logistic, and Poisson regressions modelled preoperative Hgb, the change from referral to preoperative Hgb (∆Hgb), the odds of transfusion, and the number of RBC units transfused, while accounting for baseline covariates. Higher ∆Hgb was associated with IV iron >600 mg (9.80 g/L [6.17-13.42]), epoetin alfa >80,000 U (5.80 g/L [2.20-9.40]), and higher referral Hgb (1.91 g/L [1.09-2.74] per 10 g/L). Higher preoperative Hgb (odds ratio 0.76 [0.64-0.90]; count ratio 0.84 [0.77-0.93] per 10 g/L) corresponded to a lower likelihood of being transfused and transfusion of fewer RBC units. CONCLUSIONS: Preoperative IV iron >600 mg and epoetin alfa >80,000 U each was associated with significant increases in Hgb. Higher preoperative Hgb was associated with a lower likelihood of transfusion and transfusion of fewer RBC units. The authors recommend that cumulative preoperative doses of IV iron >600 mg and epoetin alfa >80,000 U be used for treatment of anemia before cardiac surgery.
