PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery: a multicentre, observational study.
- Lasocki S From the LUNAM Université, Université d'Angers, Department of Anaesthesiology and Reanimation, University Hospital Angers, Angers, France (SL), Department of Orthopaedics, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf (RK), Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany (CVH), Vifor Pharma Ltd., Glattbrugg (AM, SC), and Institute of Anaesthesiology, University and University Hospital of Zurich, Zurich, Switzerland (DRS).
- Krauspe R
- von Heymann C
- Mezzacasa A
- Chainey S
- Spahn DR
- 2015-01-08
Published in:
- European journal of anaesthesiology. - 2015
Adolescent
Adult
Aged
Aged, 80 and over
Anemia
Biomarkers
Elective Surgical Procedures
Electronic Health Records
Erythrocyte Transfusion
Europe
Female
Ferritins
Hematinics
Hemoglobins
Humans
Male
Middle Aged
Orthopedic Procedures
Preoperative Care
Prevalence
Risk Factors
Time Factors
Transferrin
Treatment Outcome
Young Adult
English
BACKGROUND
Patient blood management (PBM) can prevent preoperative anaemia, but little is known about practice in Europe.
OBJECTIVE
To assess the pre and postoperative prevalence and perioperative management of anaemia in patients undergoing elective orthopaedic surgery in Europe.
DESIGN
An observational study; data were collected from patient records via electronic case report forms.
SETTING
Seventeen centres in six European countries. Centres were stratified according to whether they had a PBM programme or not.
PATIENTS
One thousand five hundred and thirty-four patients undergoing major elective hip, knee or spine surgery [49.9% hip, 37.2% knee, 13.0% spine; age 64.0 years (range 18 to 80), 61.3% female].
MAIN OUTCOME MEASURES
Prevalence of preoperative (primary endpoint) and postoperative anaemia [haemoglobin (Hb) <13 g dl (male), Hb <12 g dl (female)], perioperative anaemia management, time to first blood transfusion and number of transfused units. Data are shown as mean (SD) or median (interquartile range).
RESULTS
Anaemia prevalence increased from 14.1% preoperatively to 85.8% postoperatively. Mean Hb decrease was 1.9 (1.5) and 3.0 (1.3) g dl in preoperatively anaemic and nonanaemic patients, respectively (P < 0.001). In PBM (n = 7) vs. non-PBM centres, preoperative anaemia was less frequent (8.0 vs. 18.5%; P < 0.001) and iron status was assessed more frequently (ferritin 11.0 vs. 2.6%, transferrin saturation 11.0 vs. 0.1%; P < 0.001). Perioperative anaemia correction (mainly transfusion) was given to 34.3%. Intraoperatively, 14.8% of preoperatively anaemic and 2.8% of nonanaemic patients received transfusions [units per patient: 2.4 (1.5) and 2.2 (1.4), median time to first intraoperative transfusion: 130 (88, 158) vs. 179 (135, 256) min; P < 0.001]. Postoperative complications were more frequent in preoperatively anaemic vs. nonanaemic patients (36.9 vs. 22.2%; P = 0.009).
CONCLUSION
Most patients who underwent elective orthopaedic surgery had normal preoperative Hb levels but became anaemic after the procedure. Those who were anaemic prior to surgery had an increased intraoperative transfusion risk and postoperative complication rate. PBM measures such as iron status assessment and strategies to avoid transfusion are still underused in Europe.
Patient blood management (PBM) can prevent preoperative anaemia, but little is known about practice in Europe.
OBJECTIVE
To assess the pre and postoperative prevalence and perioperative management of anaemia in patients undergoing elective orthopaedic surgery in Europe.
DESIGN
An observational study; data were collected from patient records via electronic case report forms.
SETTING
Seventeen centres in six European countries. Centres were stratified according to whether they had a PBM programme or not.
PATIENTS
One thousand five hundred and thirty-four patients undergoing major elective hip, knee or spine surgery [49.9% hip, 37.2% knee, 13.0% spine; age 64.0 years (range 18 to 80), 61.3% female].
MAIN OUTCOME MEASURES
Prevalence of preoperative (primary endpoint) and postoperative anaemia [haemoglobin (Hb) <13 g dl (male), Hb <12 g dl (female)], perioperative anaemia management, time to first blood transfusion and number of transfused units. Data are shown as mean (SD) or median (interquartile range).
RESULTS
Anaemia prevalence increased from 14.1% preoperatively to 85.8% postoperatively. Mean Hb decrease was 1.9 (1.5) and 3.0 (1.3) g dl in preoperatively anaemic and nonanaemic patients, respectively (P < 0.001). In PBM (n = 7) vs. non-PBM centres, preoperative anaemia was less frequent (8.0 vs. 18.5%; P < 0.001) and iron status was assessed more frequently (ferritin 11.0 vs. 2.6%, transferrin saturation 11.0 vs. 0.1%; P < 0.001). Perioperative anaemia correction (mainly transfusion) was given to 34.3%. Intraoperatively, 14.8% of preoperatively anaemic and 2.8% of nonanaemic patients received transfusions [units per patient: 2.4 (1.5) and 2.2 (1.4), median time to first intraoperative transfusion: 130 (88, 158) vs. 179 (135, 256) min; P < 0.001]. Postoperative complications were more frequent in preoperatively anaemic vs. nonanaemic patients (36.9 vs. 22.2%; P = 0.009).
CONCLUSION
Most patients who underwent elective orthopaedic surgery had normal preoperative Hb levels but became anaemic after the procedure. Those who were anaemic prior to surgery had an increased intraoperative transfusion risk and postoperative complication rate. PBM measures such as iron status assessment and strategies to avoid transfusion are still underused in Europe.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1097/EJA.0000000000000202
- PMID 25564780
- Persistent URL
- https://folia.unifr.ch/global/documents/166059
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