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Kim EY, Park SE, Hong TH. What we should consider to facilitate recovery of the hematological profile in all patients after pancreaticoduodenectomy: the role of preoperative intravenous iron treatment. BMC Surg 2023; 23:308. [PMID: 37828447 PMCID: PMC10571369 DOI: 10.1186/s12893-023-02217-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND In pancreaticoduodenectomy (PD), the duodenum and upper jejunum responsible for iron absorption are removed, which can lead to massive hemorrhage during surgery and cause iron deficiency anemia after PD. The aim of this study was to evaluate overall changes in hematologic profiles of patients who underwent pancreaticoduodenectomy. Effect of preoperative intravenous iron treatment on recovery of anemia after surgery was also investigated. METHODS From March 2021 to December 2021, patients who underwent curative PD at our institution due to periampullary lesions were enrolled. They were divided into two groups according to whether or not iron was administered before surgery. In the IV iron group, all patients had been routinely administered with 1000 mg of ferric carboxymaltose intravenously once about 3-7 days before the operation day. Contrarily, patients in the control group did not receive intravenous iron before PD. Changes in hematological profile were measured preoperatively and at 5, 14, and 30 days postoperatively. Clinical results of the two groups were compared and analyzed. Additionally, a subgroup analysis was performed for selected non-anemic patients who had preoperative hemoglobin level of 12.0 g/dl or higher to compare changes in hematologic profiles between the two groups. RESULTS Thirty patients of the IV iron group and 34 patients of the control group were analyzed. Although no difference was observed in postoperative complications or mortality, hemoglobin and iron levels were recovered significantly faster at two weeks postoperatively in the IV iron group than in the control group. Iron levels were significantly higher in the IV iron group throughout the postoperative period. In subgroup analysis conducted for non-anemic patients, hemoglobin levels were recovered significantly faster and maintained higher in the IV iron group throughout the postoperative period, although baseline levels of hemoglobin were similar between the two groups. In addition, the length of intensive care unit stay was significantly shorter in the IV iron group than in the control group. CONCLUSIONS Preoperative intravenous iron treatment might be effective in facilitating recovery of hematologic profiles of patients during the recovery period after PD regardless of the presence of preoperative anemia, thus preventing postoperative iron deficiency anemia.
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Affiliation(s)
- Eun Young Kim
- Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Eun Park
- Division of Hepato-biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Tae Ho Hong
- Division of Hepato-biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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2
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Olivier RMR, Macke M, Müller JC, Schrader L, Eveslage M, Rauer M, Wempe C, Martens S, Zarbock A, Wagner NM, Karst U, Dogan DY, Steinbicker AU. Perioperative Tracking of Intravenous Iron in Patients Undergoing On-Pump Cardiac Surgery: A Prospective, Single-Center Pilot Trial. Anesth Analg 2023; 136:578-587. [PMID: 36811991 DOI: 10.1213/ane.0000000000006372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Preoperative intravenous iron administration is a frequently used patient blood management procedure. If the timeframe of intravenous iron administration before surgery is short, (1) the concentration of the intravenous iron compound might still be high in patients' plasma when undergoing surgery and (2) this iron in patients' plasma is at risk to be lost due to blood loss. The aim of the current study was, therefore, to track the iron compound ferric carboxymaltose (FCM) before, during, and after cardiac surgery requiring cardiopulmonary bypass, with an emphasis on intraoperative iron losses in shed blood and potential recovery through autologous cell salvage. METHODS Concentrations of FCM were analyzed in patients' blood using a hyphenation of liquid chromatography and inductively coupled plasma-mass spectrometry to distinguish between pharmaceutical compound FCM and serum iron. In this prospective, single-center pilot trial, 13 anemic and 10 control patients were included. Anemic patients with hemoglobin levels ≤12/13 g/dL in women and men were treated with 500 milligrams (mg) intravenous FCM 12 to 96 hours before elective on-pump cardiac surgery. Patients' blood samples were collected before surgery and at days 0, 1, 3, and 7 after surgery. One sample each was taken of the cardiopulmonary bypass, the autologous red blood cell concentrate generated by cell salvage, and the cell salvage disposal bag. RESULTS Patients who had received FCM <48 hours before surgery had higher FCM serum levels (median [Q1-Q3], 52.9 [13.0-91.6]) compared to ≥48 hours (2.1 [0.7-5.1] µg/mL, P = .008). Of 500-mg FCM administered <48 hours, 327.37 (257.96-402.48) mg were incorporated compared to administration ≥48 hours with 493.60 (487.78-496.70) mg. After surgery, patients' plasma FCM concentration in the FCM <48 hours group was decreased (-27.1 [-30 to -5.9] µg/mL). Little FCM was found in the cell salvage disposal bag (<48 hours, 4.2 [3.0-25.8] µg/mL, equivalent to 29.0 [19.0-40.7] mg total; equivalent to 5.8% or 1/17th of the 500 mg FCM initially administered), almost none in the autologous red blood cell concentrate (<48 hours, 0.1 [0.0-0.43] µg/mL). CONCLUSIONS The data generate the hypotheses that nearly all FCM is incorporated into iron stores with administration ≥48 hours before surgery. When FCM is given <48 hours of surgery, the majority is incorporated into iron stores by the time of surgery, although a small amount may be lost during surgical bleeding with limited recovery by cell salvage.
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Affiliation(s)
- Roman M R Olivier
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Marcel Macke
- Institute of Inorganic and Analytical Chemistry, University of Muenster, Muenster, Germany
| | - Jennifer C Müller
- Institute of Inorganic and Analytical Chemistry, University of Muenster, Muenster, Germany
| | - Lisa Schrader
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Marcel Rauer
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Carola Wempe
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Sven Martens
- Department of Thoracic, Heart and Vascular Surgery, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Alexander Zarbock
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Nana-Maria Wagner
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Muenster, Muenster, Germany
| | - Deniz Y Dogan
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany.,Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Andrea U Steinbicker
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany.,Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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3
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Laermans J, Van Remoortel H, Avau B, Bekkering G, Georgsen J, Manzini PM, Meybohm P, Ozier Y, De Buck E, Compernolle V, Vandekerckhove P. Adverse events of iron and/or erythropoiesis-stimulating agent therapy in preoperatively anemic elective surgery patients: a systematic review. Syst Rev 2022; 11:224. [PMID: 36253838 PMCID: PMC9578279 DOI: 10.1186/s13643-022-02081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iron supplementation and erythropoiesis-stimulating agent (ESA) administration represent the hallmark therapies in preoperative anemia treatment, as reflected in a set of evidence-based treatment recommendations made during the 2018 International Consensus Conference on Patient Blood Management. However, little is known about the safety of these therapies. This systematic review investigated the occurrence of adverse events (AEs) during or after treatment with iron and/or ESAs. METHODS Five databases (The Cochrane Library, MEDLINE, Embase, Transfusion Evidence Library, Web of Science) and two trial registries (ClinicalTrials.gov, WHO ICTRP) were searched until 23 May 2022. Randomized controlled trials (RCTs), cohort, and case-control studies investigating any AE during or after iron and/or ESA administration in adult elective surgery patients with preoperative anemia were eligible for inclusion and judged using the Cochrane Risk of Bias tools. The GRADE approach was used to assess the overall certainty of evidence. RESULTS Data from 26 RCTs and 16 cohort studies involving a total of 6062 patients were extracted, on 6 treatment comparisons: (1) intravenous (IV) versus oral iron, (2) IV iron versus usual care/no iron, (3) IV ferric carboxymaltose versus IV iron sucrose, (4) ESA+iron versus control (placebo and/or iron, no treatment), (5) ESA+IV iron versus ESA+oral iron, and (6) ESA+IV iron versus ESA+IV iron (different ESA dosing regimens). Most AE data concerned mortality/survival (n=24 studies), thromboembolic (n=22), infectious (n=20), cardiovascular (n=19) and gastrointestinal (n=14) AEs. Very low certainty evidence was assigned to all but one outcome category. This uncertainty results from both the low quantity and quality of AE data due to the high risk of bias caused by limitations in the study design, data collection, and reporting. CONCLUSIONS It remains unclear if ESA and/or iron therapy is associated with AEs in preoperatively anemic elective surgery patients. Future trial investigators should pay more attention to the systematic collection, measurement, documentation, and reporting of AE data.
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Affiliation(s)
- Jorien Laermans
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium. .,Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.
| | - Hans Van Remoortel
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Bert Avau
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Geertruida Bekkering
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,Center for Evidence-Based Medicine, Leuven, Belgium.,Cochrane Belgium, Leuven, Belgium
| | - Jørgen Georgsen
- South Danish Transfusion Service, Odense University Hospital, Odense C, Denmark
| | - Paola Maria Manzini
- SC Banca del Sangue Servizio di Immunoematologia, University Hospital Città della Salute e della Scienza di Torino, Torino, Italy
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Yves Ozier
- University Hospital of Brest, Brest, France
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Veerle Compernolle
- Blood Services, Belgian Red Cross, Mechelen, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,Belgian Red Cross, Mechelen, Belgium.,Centre for Evidence-Based Health Care, Stellenbosch University, Cape Town, South Africa
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4
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Guinn NR, Fuller M, Murray S, Aronson S. Treatment through a preoperative anemia clinic is associated with a reduction in perioperative red blood cell transfusion in patients undergoing orthopedic and gynecologic surgery. Transfusion 2022; 62:809-816. [PMID: 35275418 DOI: 10.1111/trf.16847] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preoperative anemia is associated with increased morbidity, mortality, and risk of transfusion. Treatment through a preoperative anemia clinic (PAC) may improve outcomes. STUDY DESIGN AND METHODS Adult patients undergoing elective orthopedic and gynecologic surgery with preoperative anemia were identified and referred for hemoglobin optimization with iron and/or erythropoietin from a single-site academic health center. Treated patients were propensity matched to untreated controls and compared on outcomes of erythrocyte transfusion, length of stay (LOS), and readmission. Changes in hemoglobin relative to treatment time before surgery were also measured in the treated cohort. RESULTS One thousand three hundred thirty-two patients were evaluated between July 2015 and March 2021, of which 161 underwent optimization through the PAC. After propensity matching, 127 (98 orthopedic and 29 gynecology) PAC-treated patients were compared to 127 (98 orthopedic and 29 gynecology) control patients who did not undergo treatment. The primary outcome of perioperative transfusion was significantly lower in treated patients compared with matched controls (12.60% vs. 26.77%, p = .005). A lower LOS was demonstrated in the gynecologic PAC subgroup (2.2 [1.5, 2.4] vs. 3.1 [2.2, 3.4], p = .002). Each day of treatment time before surgery was associated with an increase of 0.040 g/dL hemoglobin (p < .001) until 65 days, after which further time did not increase hemoglobin. CONCLUSION Treatment through a preoperative anemia clinic is associated with a reduction in perioperative transfusion and possible reduction in LOS and readmission compared with matched controls. Additionally, treatment time before surgery is correlated with a greater increase in hemoglobin up until 2 months prior to surgery.
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Affiliation(s)
- Nicole R Guinn
- Department Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Matt Fuller
- Department Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sutton Murray
- Department Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Solomon Aronson
- Department Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Science, Duke University School of Medicine, Durham, North Carolina, USA
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5
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Casellas Caro M, Hidalgo MJC, García-Erce JA, Baquero Úbeda JL, Torras Boatella MG, Gredilla Díaz E, Ruano Encinar M, Martín Bayón I, Nicolás Picó J, Arjona Berral JE, Muñoz Solano A, Jiménez Merino S, Cerezales M, Cuervo J. Applying reflective multicriteria decision analysis to understand the value of therapeutic alternatives in the management of gestational and peripartum anaemia in Spain. BMC Pregnancy Childbirth 2022; 22:157. [PMID: 35216553 PMCID: PMC8881868 DOI: 10.1186/s12884-022-04481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain. METHODS Ferric carboxymaltose (FCM) and ferrous sulphate were evaluated using the EVIDEM framework. Ten stakeholders participated to collect different perspectives. The framework was adapted considering evidence retrieved with a PICO-S search strategy and grey literature. Criteria/subcriteria were weighted by level of relevance and an evidence-based decision-making exercise was developed in each criterion; weights and scores were combined to obtain the value of intervention relative to each criterion/subcriterion, that were further combined into the Modulated Relative Benefit-Risk Balance (MRBRB). RESULTS The most important criterion favouring FCM was Compared Efficacy/Effectiveness (0.183 ± 0.07), followed by Patient Preferences (0.059 ± 0.10). Only Direct medical costs criterion favoured FS (-0.003 ± 0.03). MRBRB favoured FCM; 0.45 ± 0.19; in a scale from -1 to + 1. CONCLUSIONS In conclusion, considering the several criteria involved in the decision-making process, participants agreed with the use of FCM according to its MRBRB.
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Affiliation(s)
- Manel Casellas Caro
- Department of Obstetrics, Hospital Universitari Vall d´Hebron, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - María Jesús Cancelo Hidalgo
- Department of Obstetrics and Gynecology, Hospital Universitario Guadalajara, Calle Donante de Sangre, 19002, Guadalajara, S/N, Spain
| | - José Antonio García-Erce
- Banco de Sangre Y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Calle Irunlarrea, 3, 31008, Pamplona, Spain
- Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de La Salud, Avenida San Juan Bosco, 13, 50009, Zaragoza, Spain
- PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana, 261, 28046, Madrid, Spain
| | | | - Maria Glòria Torras Boatella
- Àrea d'Innovació, Hospital Universitari Bellvitge, Carrer de La Feixa Llarga, L'Hospitalet de Llobregat, 08907, Barcelona, S/N, Spain
- Institut Català de La Salut, Barcelona, Spain
| | - Elena Gredilla Díaz
- Anaesthesia Department, Hospital La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | | | - Israel Martín Bayón
- CS Polop-La Nucía, Avenida de Sagi Barba, 24, Polop, La Nucía, 03520, Alicante, Spain
| | - Jordi Nicolás Picó
- Hospital Universitari Mutua Terrasa, Plaça del Doctor Robert, 5, 08221, Terrassa, Spain
| | | | - Alberto Muñoz Solano
- Department of Obstetrics and Gynecology, Hospital Universitario Marqués de Valdecilla, Avenida de Valdecilla, 25, 39008, Santander, Spain
| | | | - Mónica Cerezales
- Axentiva Solutions S.L., Calle Monte Cerrau, 28, 33006, Asturias, Oviedo, Spain
| | - Jesús Cuervo
- Axentiva Solutions S.L., Calle Monte Cerrau, 28, 33006, Asturias, Oviedo, Spain.
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6
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Borgmeier E, Lawrence H, Morton C, McEvoy MD. Perioperative anemia management. Int Anesthesiol Clin 2022; 60:1-7. [PMID: 34897216 DOI: 10.1097/aia.0000000000000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Emilee Borgmeier
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | - Heather Lawrence
- Hi-RiSE Preoperative Optimization Clinic, Vanderbilt University Medical Center
| | - Colleen Morton
- Department of Medicine, Vanderbilt University Medical Center
| | - Matthew D McEvoy
- Vanderbilt University School of Medicine
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
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7
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Eisler L, Chihuri S, Lenke LG, Sun LS, Faraoni D, Li G. Development of a preoperative risk score predicting allogeneic red blood cell transfusion in children undergoing spinal fusion. Transfusion 2022; 62:100-115. [PMID: 34761400 PMCID: PMC8758528 DOI: 10.1111/trf.16722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Children undergoing spinal fusion often receive blood products. The goal of this study was to develop a preoperative score to help physicians identify those who are at risk of allogeneic red blood cell (RBC) transfusion. STUDY DESIGN AND METHODS This retrospective study of children undergoing spinal fusion in the ACS-NSQIP Pediatric database (2016-2019) aimed at identifying risk factors associated with allogeneic RBC transfusion. Univariable logistic regression and multivariable logistic regression were performed using preoperative patient characteristics and aided in the creation of a simplified scoring system. RESULTS Out of 13,929 total patients, 2990 (21.5%) were transfused. We created a risk score based on 10 independent predictors of transfusion: age, sex, race, weight < 3rd percentile, American Society of Anesthesiologists physical status classification, cardiac risk factors, hematologic disease, preoperative anemia, deformity type, and number of spinal levels to be fused. Patients in both the training and testing cohorts were assigned a score ranging from 0 (lowest risk) to 21 (highest risk). The developed transfusion risk score showed 77% accuracy in distinguishing patients who did not receive a transfusion during or soon after surgery (AUROC 0.7736 [95% CI, 0.7619-0.7852]) in the training cohort and 77% accuracy (AUROC 0.7732 [95% CI, 0.7554-0.7910]) in the testing cohort. DISCUSSION Our score, based on routinely available preoperative data, accurately estimates the risk of allogeneic RBC transfusion in pediatric patients undergoing spinal fusion. Future studies will inform whether patient blood management interventions targeted to high-risk patients can help reduce the need for transfusion and improve outcomes.
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Affiliation(s)
- Lisa Eisler
- Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Stanford Chihuri
- Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Lawrence G. Lenke
- Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Lena S. Sun
- Anesthesiology and Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY
| | - David Faraoni
- Anesthesiology, Perioperative and Pain Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Guohua Li
- Anesthesiology and Epidemiology, Columbia University College of Physicians and Surgeons, New York, NY
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8
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Adeleke I, Chae C, Okocha O, Sweitzer B. Risk assessment and risk stratification for perioperative complications and mitigation: Where should the focus be? How are we doing? Best Pract Res Clin Anaesthesiol 2021; 35:517-529. [PMID: 34801214 DOI: 10.1016/j.bpa.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/07/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023]
Abstract
Various risk stratification tools are used to predict patients' risk of adverse outcomes. Most of these tools are based on type of surgery and patient comorbidities. Accuracy of risk prediction is improved when additional factors such as functional capacity are included. However, these tools are limited because data are obtained from specific patient populations, are simplified to aid ease of use, and do not account for improved treatment modalities that occur over time. Risk estimation allows for shared decision-making among the perioperative care team and the patient, for perioperative planning, and for opportunity for risk mitigation. Technological advancement in data collection will likely improve existing risk assessment and allow development of new options. Future research should focus on establishing and standardizing perioperative outcomes that include meaningful patient-centric considerations such as quality of life. We review available stratification tools and important risk assessment biomarkers that address the most common causes of adverse outcomes.
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Affiliation(s)
- Ibukun Adeleke
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
| | - Christina Chae
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
| | - Obianuju Okocha
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
| | - BobbieJean Sweitzer
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Feinberg 5-704, 251 East Huron Street Chicago 60611, IL, USA.
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9
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Patel SY, Kubal TE, Li R, Manley BJ, Gilbert SM, Sexton WJ, Spiess PE, Boulware D, Poch MA. Prevalence of Preoperative Iron Deficiency Anemia: A Case Series Among Patients Undergoing Radical Cystectomy. A A Pract 2021; 15:e01477. [PMID: 33999012 DOI: 10.1213/xaa.0000000000001477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anemia occurs in a significant group of patients with bladder cancer before radical cystectomy. Iron deficiency is a readily identifiable cause of anemia, which can be treated before surgery. The proportion of patients with bladder cancer with iron deficiency anemia is unknown. Laboratory and clinical outcomes were collected on 47 consecutive patients presenting for radical cystectomy. Iron studies found 30% of patients had iron deficiency anemia. These findings present an opportunity to treat anemia before surgery, to reduce blood transfusions during radical cystectomy.
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Affiliation(s)
| | | | - Roger Li
- Department of Genitourinary Oncology
| | | | | | | | | | - David Boulware
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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10
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Perelman SI, Shander A, Mabry C, Ferraris VA. Preoperative anemia management in the coronavirus disease (COVID-19) era. JTCVS OPEN 2021; 5:85-94. [PMID: 34173552 PMCID: PMC7836783 DOI: 10.1016/j.xjon.2020.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Seth I. Perelman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Aryeh Shander
- TeamHealth Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Health, Englewood, NJ
| | - Christian Mabry
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Victor A. Ferraris
- Department of Cardiothoracic Surgery, Lexington VA Medical Center, University of Kentucky, Lexington, Ky
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11
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Abdullah HR, Thamnachit T, Hao Y, Lim WY, Teo LM, Sim YE. Real-world results of the implementation of preoperative anaemia clinic with intravenous iron therapy for treating iron-deficiency anaemia: a propensity-matched case-control study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:6. [PMID: 33553299 PMCID: PMC7859766 DOI: 10.21037/atm-20-4942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Preoperative anaemia is associated with blood transfusion and longer hospital length of stay. Preoperative iron deficiency anaemia (IDA) can be treated with oral or intravenous (IV) iron. IV iron can raise haemoglobin faster compared with oral iron. However, its ability to reduce blood transfusion and length of stay in clinical trials is inconclusive. This study aims to compare blood transfusion and hospital length of stay between anemic patients who received preoperative IV iron versus standard care, after implementation of a protocol in 2017 to screen patients for preoperative IDA, and its treatment with IV iron. Methods Retrospective before-after cohort study comparing 89 patients who received IV iron preoperatively in 2017, with historic patients who received oral iron therapy (selected by propensity score matching (PSM) from historic cohort of 7,542 patients who underwent surgery in 2016). Propensity score was calculated using ASA status, age, gender, surgical discipline, surgical risk and preoperative haemoglobin concentration. Both 1:1 and 1:2 matching were performed as sensitivity analysis. Results After PSM, there was no statistically significant difference in distribution of preoperative clinical variables. There was no significant difference in proportion of cases requiring transfusion nor a difference in average units transfused per patient. IV iron cohort stayed in hospital on average 8.0 days compared to non-IV iron cohort 14.1–15.1 days (P=0.006, P=0.013 respectively). Average time from IV iron therapy to surgery was 10.5 days. Conclusions Preoperative IV iron therapy for patients with IDA undergoing elective surgery may not reduce perioperative blood transfusion, but this could be due to the short time between therapy and surgery. Implementation of IV iron therapy may reduce hospital length of stay compared to standard care for anemic patients, although this may be enhanced by concomitant improvement in perioperative care.
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Affiliation(s)
- Hairil R Abdullah
- Department of Anaesthesiology, Singapore General Hospital, 169608, Singapore
| | - Tanakorn Thamnachit
- Department of Anaesthesiology, Singapore General Hospital, 169608, Singapore
| | - Ying Hao
- Health Services Research Centre (HSRC), Singapore Health Services, 169608, Singapore
| | - Wan Yen Lim
- Department of Anaesthesiology, Singapore General Hospital, 169608, Singapore
| | - Li Ming Teo
- Department of Anaesthesiology, Singapore General Hospital, 169608, Singapore
| | - Yilin Eileen Sim
- Department of Anaesthesiology, Singapore General Hospital, 169608, Singapore
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Corwin HL, Shander A, Speiss B, Muñoz M, Faraoni D, Calcaterra D, Welsby I, Ozawa S, Arnofsky A, Goldweit RS, Tibi P. Management of Perioperative Iron Deficiency in Cardiac Surgery: A Modified RAND Delphi Study. Ann Thorac Surg 2020; 113:316-323. [PMID: 33345781 DOI: 10.1016/j.athoracsur.2020.11.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/29/2020] [Accepted: 11/10/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Over the last decade, preoperative anemia has become recognized as a clinical condition in need of management. Although the etiology of preoperative anemia can be multifactorial, two-thirds of anemic elective surgical patients have iron deficiency anemia. At the same time, one-third of non-anemic elective surgical patients are also iron deficient. METHODS Modified-RAND Delphi methodology was employed to identify areas of consensus among an expert panel regarding the management of iron deficiency in patients undergoing cardiac surgery. A list of statements was sent to panel members to respond to using a five-point Likert Scale. All panel members subsequently attended a face-to-face meeting. The initial survey was presented and discussed, and panel members responded to each statement on the Likert scale again. Based on the second survey, the panel came to a consensus on recommendations. RESULTS The panel recommended all patients undergoing cardiac surgery be evaluated for iron deficiency, whether or not anemia is present. Evaluation should include iron studies and reticulocyte hemoglobin content. If iron deficiency is present, with or without anemia, patients should receive parenteral iron. Erythropoietin stimulating agents may be appropriate for some patients. CONCLUSIONS Consensus of an expert panel resulted in a standardized approach to diagnosing and managing iron deficiency in patients undergoing cardiac surgery.
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Affiliation(s)
- Howard L Corwin
- Critical Care Medicine, Geisinger Health System Danville, PA.
| | - Aryeh Shander
- Department of Anesthesiology and Critical Care Medicine, Englewood Health, TeamHealth, Englewood, NJ
| | - Bruce Speiss
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | - Manuel Muñoz
- Department of Surgical Specialties, Biochemistry, and Immunology, University of Malaga School of Medicine, Malaga, Spain
| | - David Faraoni
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Domenico Calcaterra
- Department of Cardiothoracic Surgery, Bethesda Heart Hospital, Baptist South Florida, Boynton Beach, FL
| | - Ian Welsby
- Department of Anesthesiology and Critical Care, Duke University School of Medicine, Durham, NC
| | - Sherri Ozawa
- Patient Blood Management, Englewood Hospital and Medical Center, Englewood, NJ
| | - Adam Arnofsky
- Cardiothoracic Surgery, Englewood Hospital and Medical Center, Englewood, NJ
| | - Richard S Goldweit
- Interventional Cardiology, Englewood Hospital and Medical Center, Englewood, NJ
| | - Pierre Tibi
- Department of Cardiothoracic and Vascular Diseases, Yavapai Regional Medical Center, Prescott, AZ
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13
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Steiner K, Baron-Stefaniak J, Hirschl AM, Barousch W, Willinger B, Baron DM. Education of medical personnel optimizes filling volume of blood culture bottles without negatively affecting microbiology testing. BMC Health Serv Res 2020; 20:1105. [PMID: 33256736 PMCID: PMC7704116 DOI: 10.1186/s12913-020-05959-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/23/2020] [Indexed: 12/03/2022] Open
Abstract
Background Anemia is a risk factor for adverse outcomes, which can be aggravated by unnecessary phlebotomies. In blood culture testing, up to 30 ml of blood can be withdrawn per sample, even though most manufacturers recommend blood volumes of 10 ml or less. After assessing the filling volume of blood culture bottles at our institution, we investigated whether an educational intervention could optimize filling volume of blood culture bottles without negatively affecting microbiology testing. Methods We weighed 10,147 blood cultures before and 11,806 blood cultures after a six-month educational intervention, during which employees were trained regarding correct filling volume via lectures, handouts, emails, and posters placed at strategic places. Results Before the educational intervention, only 31% of aerobic and 34% of anaerobic blood cultures were filled correctly with 5–10 ml of blood. The educational intervention increased the percentage of correctly filled bottles to 43% (P < 0.001) for both aerobic and anaerobic samples without negatively affecting results of microbiologic testing. In addition, sample volume was reduced from 11.0 ± 6.5 to 9.4 ± 5.1 ml (P < 0.001) in aerobic bottles and from 10.1 ± 5.6 to 8.8 ± 4.8 ml (P < 0.001) in anaerobic bottles. Conclusion Education of medical personnel is a simple and effective way to reduce iatrogenic blood loss and possibly moderate the extent of phlebotomy-induced anemia.
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Affiliation(s)
- Katrin Steiner
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Joanna Baron-Stefaniak
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexander M Hirschl
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Wolfgang Barousch
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Birgit Willinger
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - David M Baron
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Wittenmeier E, Paumen Y, Mildenberger P, Smetiprach J, Pirlich N, Griemert EV, Kriege M, Engelhard K. Non-invasive haemoglobin measurement as an index test to detect pre-operative anaemia in elective surgery patients - a prospective study. Anaesthesia 2020; 76:647-654. [PMID: 33227153 DOI: 10.1111/anae.15312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Abstract
Non-invasive haemoglobin measurement using absolute values lacks the precision to be the sole basis for the treatment of pre-operative anaemia. However, it can possibly serve as a screening test, indexing 'anaemia' with high sensitivity when values remain under prespecified cut-off values. Based on previous data, non-invasive haemoglobin cut-off values (146 g.l-1 for women and 152 g.l-1 for men) detect true anaemia with 99% sensitivity. An index test with these prespecified cut-off values was verified by prospective measurement of non-invasive and invasive haemoglobin pre-operatively in elective surgical patients. In 809 patients, this showed an estimated sensitivity (95%CI) of 98.9% (94.1-99.9%) in women and 96.4% (91.0-99.0%) in men. This saved invasive blood tests in 9% of female and 28% of male patients. In female patients, a lower non-invasive haemoglobin cut-off value (138 g.l-1 ) would save 28% of invasive blood tests with a sensitivity of 95%. The target 99% sensitivity would be reached by non-invasive haemoglobin cut-off values of 152 g.l-1 in female and 162 g.l-1 in male patients, saving 3% and 9% of invasive blood tests, respectively. Bias and limits of agreement between non-invasive and laboratory haemoglobin levels were 2 and - 25 to 28 g.l-1 , respectively. Patient and measurement characteristics did not influence the agreement between non-invasive and laboratory haemoglobin levels. Although sensitivity was very high, the index test using prespecified cut-off values just failed to reach the target sensitivity to detect true anaemia. Nevertheless, with respect to blood-sparing effects, the use of the index test in men may be clinically useful, while an index test with a lower cut-off (132 g.l-1 ) could be more clinically appropriate in women.
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Affiliation(s)
- E Wittenmeier
- Department of Anaesthesiology, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - Y Paumen
- Department of Anaesthesiology, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - P Mildenberger
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - J Smetiprach
- Department of Anaesthesiology, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - N Pirlich
- Department of Anaesthesiology, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - E-V Griemert
- Department of Anaesthesiology, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - M Kriege
- Department of Anaesthesiology, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - K Engelhard
- Department of Anaesthesiology, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
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Switzer T, Naraine N, Chamlati R, Lau W, McVey MJ, Zaarour C, Faraoni D. Association between preoperative hemoglobin levels after iron supplementation and perioperative blood transfusion requirements in children undergoing scoliosis surgery. Paediatr Anaesth 2020; 30:1077-1082. [PMID: 32748472 DOI: 10.1111/pan.13987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/08/2020] [Accepted: 07/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS In this study, we assessed the association between preoperative hemoglobin and red blood cell transfusion in children undergoing spine surgery after the implementation of our preoperative iron supplementation protocol. METHOD We performed a retrospective analysis of patients who underwent posterior spinal fusion surgery between January 2013 and December 2017 and received preoperative iron supplementation. We used uni- and multivariable logistic regression to determine the association between preoperative hemoglobin level and red blood cell transfusion in patients receiving iron supplementation. RESULTS A total of 382 patients treated with preoperative oral iron were included. Of these, 175 (45.5%) patients were transfused intraoperatively. Multivariable logistic regression analysis revealed nonidiopathic etiology of the scoliosis (OR 4.178 [95% CI: 2.277-7.668], P < .001), the Cobb angle (OR 1.025 [95% CI: 1.010-1.040], P = .001), and number of vertebrae fused (OR 1.169 [95% CI: 1.042-1.312], P = .008) were associated with red blood cell transfusion. In addition, patients with a preoperative hemoglobin ≥ 140 g/L (OR 0.157 [95% CI: 0.046-0.540], P = .003), and hemoglobin between 130 and 140 g/L (OR 0.195 [95% CI: 0.057-0.669], P = .009) were less likely to be transfused compared with patients with preoperative hemoglobin between 120 and 130 g/L (OR 0.294 [95% CI: 0.780-1.082], P = .066) or <120 g/L (reference). CONCLUSION Our study suggests that higher preoperative hemoglobin levels (>130 g/L) are associated with a reduced need for red blood cell transfusion in pediatric patients who have received iron supplementation before undergoing posterior spinal fusion in our institution. The effect of iron supplementation, the optimal dosing, and duration of supplemental iron therapy remains unclear at this time.
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Affiliation(s)
- Timothy Switzer
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Nadia Naraine
- Department of Pediatric Laboratory Medicine, Transfusion Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Racha Chamlati
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Wendy Lau
- Department of Pediatric Laboratory Medicine, Transfusion Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mark J McVey
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Christian Zaarour
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - David Faraoni
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Mabry C, Perelman S, Kim JT, Blitz JD. Implementation of a Preoperative Anemia Clinic Utilizing a Minimal Staffing Model. A A Pract 2020; 14:90-94. [PMID: 31770131 DOI: 10.1213/xaa.0000000000001131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We present a process map for the implementation of a program to treat preoperative anemia utilizing 1 existing anesthesiologist in the preoperative evaluation clinic. In the first 7 months postimplementation, 342 patients were screened for anemia, 166 were diagnosed, and 107 were treated. The mean increase in hemoglobin in treated patients was ~2 g/dL (range 0-4.9 g/dL). Two patients' surgeries were delayed in favor of treatment and 3 surgical patients, who had received 2 complete iron infusions, received an intraoperative transfusion. The total revenue generated for the institution was enough to subsidize the cost of an additional anesthesiologist.
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Affiliation(s)
- Christian Mabry
- From the Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, New York
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17
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Ranucci M, Pavesi M, Pistuddi V, Baryshnikova E. Preoperative Anemia Correction in Cardiac Surgery: A Propensity-Matched Study. J Cardiothorac Vasc Anesth 2020; 35:874-881. [PMID: 32741609 DOI: 10.1053/j.jvca.2020.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Marco Ranucci
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
| | - Marco Pavesi
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Valeria Pistuddi
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Ekaterina Baryshnikova
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
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18
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Günaydın B, Işık G, Bağcaz S, İnan G, Bozkurt N, Özkurt ZN, Onan MA. Retrospective Evaluation of Effects of Preoperative Anaemia Treatment in Gynaecological and Obstetric Surgical Patients. Turk J Anaesthesiol Reanim 2020; 49:25-29. [PMID: 33718902 PMCID: PMC7932708 DOI: 10.5152/tjar.2020.484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Objective In anemic patients undergoing surgery, there is an increase in the requirement of blood transfusion, longer hospital stay and higher intensive care unit adimission. In this study we aimed to evaluate the efficacy of iv iron treatment before elective obstetric or gynecological operations retrospectively. Methods After obtaining approval of ethics committee, records of 5688 patients underwent either obstetric or gynecological surgery between January 1st of 2016 to December 31st of 2018 were documented retrospectively and 241 anemic cases were identified. Eighty-one anemic patients who did not receive any iv iron treatment preoperatively were excluded and 160 cases treated with either iv iron (either sucrose or ferric carboxy maltose) were included. The laboratory results including haemoglobin (Hb), MCV,MCH and serum iron binding capacities, ferritin, iron and transferrin levels were documented before (preoperative) and after iv iron treatment (postoperative 10th day) were collected from files. Difference between preoperative and postoperative Hb, MCV, MCH, TIBC, serum ferritin, iron and transferrin levels of these cases were determined. Results In 97 obstetric cases, the differences of Hb, MCV, MCH, serum iron, ferritin, iron binding capacity values before surgery and postoperative 10th day were respectively found as 1.3 g dL-1 (p=0.000); 1.9 fL (p=0.000); 0.3 pg (p=0.01); 44.4 μg dL-1 (p=0.008); 85.9 μg L-1 (p=0.009); 211.7 μg dL-1 (p=0.001). In 63 gynecologic cases, same measurements were evaluated and similar differences in Hb, MCV, MCH, serum ferritin and transferrin saturation values were 1.25 g dL-1 (p=0.000); 2.2 fL (p=0.000); 0.8 pg (p=0.000); 215.6 μg L-1 (p=0.002); 41.5% (p=0.044). Two obstetric patients and 7 gynaecologic patients were transfused erytrocyte suspensions after surgery. Conclusion Efficacy of preoperative iv iron therapy in gynaecologic-obstetric patients with IDA has been demonstrated and its importance has been revisited once again.
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Affiliation(s)
- Berrin Günaydın
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Gizem Işık
- Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey
| | - Selin Bağcaz
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Gözde İnan
- Department of Anaesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - Nuray Bozkurt
- Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey
| | - Zübeyde Nur Özkurt
- Department of Hematology, Gazi University School of Medicine, Ankara, Turkey
| | - M Anıl Onan
- Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey
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19
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Preoperative considerations for Jehovah's Witness patients: a clinical guide. Curr Opin Anaesthesiol 2020; 33:432-440. [DOI: 10.1097/aco.0000000000000871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Meybohm P, Westphal S, Ravn HB, Ranucci M, Agarwal S, Choorapoikayil S, Spahn DR, Ahmed AB, Froessler B, Zacharowski K. Perioperative Anemia Management as Part of PBM in Cardiac Surgery – A Narrative Updated Review. J Cardiothorac Vasc Anesth 2020; 34:1060-1073. [DOI: 10.1053/j.jvca.2019.06.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/18/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022]
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An Effective and Efficient Testing Protocol for Diagnosing Iron-deficiency Anemia Preoperatively. Anesthesiology 2020; 133:109-118. [PMID: 32205552 DOI: 10.1097/aln.0000000000003263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Iron-deficiency anemia is a common perioperative condition and increases perioperative morbidity and mortality. Timely diagnosis and treatment are important. This retrospective cohort study tested the hypothesis that a newly developed preprocedure evaluation protocol diagnoses more patients with iron-deficiency anemia than the traditional practice of obtaining a complete blood count followed by iron studies. METHODS The preprocedure anemia evaluation is an order for a complete blood count and reflex anemia testing, which can be completed with a single patient visit. A hemoglobin concentration of 12 g/dl or less with serum ferritin concentration less than 30 ng/ml or transferrin saturation less than 20% defined iron-deficiency anemia. Northwestern Medicine's database was queried for preoperative clinic patients, age 16 to 89 yr, before (2015 to 2016) and after (2017 to 2018) protocol implementation. The proportion of patients diagnosed with iron-deficiency anemia before and after the preprocedure anemia evaluation implementation was compared. RESULTS Before implementing the protocol, 8,816 patients were screened with a traditional complete blood count. Subsequent iron studies at the providers' discretion diagnosed 107 (1.2%) patients with iron-deficiency anemia. Some patients were still screened with a complete blood count after implementing the protocol; 154 of 4,629 (3.3%) patients screened with a complete blood count and 738 of 2,828 (26.1%) patients screened with the preprocedure anemia evaluation were diagnosed with iron-deficiency anemia. The preprocedure anemia evaluation identified a far larger proportion of patients with iron-deficiency anemia than did the traditional complete blood count when compared both before (relative risk [95% CI], 21.5 (17.6 to 26.2); P < 0.0001) and after (7.8 [6.6 to 9.3]; P < 0.0001) its implementation. CONCLUSIONS The preprocedure anemia evaluation improved identification of iron-deficiency anemia preoperatively. It is more effective and efficient, allowing anemia evaluation with a single patient visit.
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Aronson S, Grocott MPW, Mythen MMG. Preoperative Patient Preparation, Programs, and Education in the United States: State of the Art, State of the Science, and State of Affairs. Adv Anesth 2019; 37:127-143. [PMID: 31677653 DOI: 10.1016/j.aan.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Solomon Aronson
- Anesthesiology and Population Health Science, Duke University School of Medicine, DUMC 3094, MS 33, 103 Baker House, Durham, NC 27710, USA.
| | - Mike P W Grocott
- University Southampton, University Road, South Hampton SO17 1BJ, UK
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Lichtenegger P, Schiefer J, Graf A, Berlakovich G, Faybik P, Baron DM, Baron-Stefaniak J. The association of pre-operative anaemia with survival after orthotopic liver transplantation. Anaesthesia 2019; 75:472-478. [PMID: 31701527 PMCID: PMC7078747 DOI: 10.1111/anae.14918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
Anaemia is common in patients with end-stage liver disease. Pre-operative anaemia is associated with greater mortality after major surgery. We analysed the association of pre-operative anaemia (World Health Organization classification) with survival and complications after orthotopic liver transplantation using Cox and logistic regression models. We included patients undergoing their first orthotopic liver transplantation between 2004 and 2016. Out of 599 included patients, 455 (76%) were anaemic before transplantation. Pre-operative anaemia was not associated with the survival of 485/599 (81%) patients to 1 year after liver transplantation, OR (95%CI) 1.04 (0.64-1.68), p = 0.88. Pre-operative anaemia was associated with higher rates of intra-operative blood transfusions and acute postoperative kidney injury on multivariable analysis, OR (95%CI) 1.70 (0.82-2.59) and 1.72 (1.11-2.67), respectively, p < 0.001 for both. Postoperative renal replacement therapy was associated with pre-operative anaemia on univariate analysis, OR (95%CI) 1.87 (1.11-3.15), p = 0.018.
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Affiliation(s)
- P Lichtenegger
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - J Schiefer
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - A Graf
- Section for Medical Statistics, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - G Berlakovich
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - P Faybik
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - D M Baron
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - J Baron-Stefaniak
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
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Abstract
To improve quality and outcomes, a preoperative anemia clinic (PAC) was established to screen, evaluate, and manage preoperative anemia. A retrospective review of primary and revision hip and knee arthroplasty patients from August 2013 to September 2017 was conducted. Patients at "high risk" for transfusion were referred to PAC for treatment with iron, erythropoietin, or both based on anemia type. Preoperative anemia clinic referred patients were compared with a 1:3 historic propensity-matched control set of patients to help determine impact of PAC. Forty PAC patients were compared with 120 control patients. Among PAC patients, 26 (63.41%) received iron only, 3 (7.32%) received erythropoietin (EPO) only, and 12 (29.27%) received both. Preoperative hemoglobin significantly increased in the treatment group (median [interquartile range] 10.9 g/dl [10.3-11.2] vs. 12.0 g/dl [11.2-12.7]; p < .001). Four PAC patients (10.00%) received red blood cell transfusions compared with 29 (24.17%) from matched controls (p = .055). In addition, the PAC cohort had higher postoperative nadir hemoglobin levels (mean [SD] 9.7 g/dl [1.31] vs. 8.7 g/dl [1.25]; p < .001). High-risk patients appropriately treated with iron and/or EPO before surgery demonstrate a significant increase in preoperative hemoglobin, trend toward decrease perioperative transfusion, and increased hemoglobin levels postoperatively compared with matched controls.
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Bolliger D, Buser A, Tanaka KA. Transfusion Requirements in Anesthesia and Intensive Care. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00320-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
PURPOSE OF REVIEW Anemia can contribute negatively to a patient's morbidity and mortality. Which treatment options do exist and what role do anesthesiologists play in management of perioperative anemia treatment? This review gives an overview about recent findings. RECENT FINDINGS Patient Blood Management and standards for the management and treatment of anemia have been established worldwide. Various logistic settings and approaches are possible. With a special focus on cardiovascular anesthesia, intravenous iron is a therapeutic option in the preoperative setting. Autologous blood salvage is a standard procedure during surgery. Restrictive transfusion triggers in adult cardiac surgery have been shown to be beneficial in the majority of studies. Elderly patients and defined comorbidities might require higher transfusion triggers. Both, intravenous and oral iron increase hemoglobin values when given prior to surgery. Oral iron is effective when given several weeks prior to elective surgery. Erythropoietin is a treatment decision individualized to each patient. SUMMARY Within the previous 18 months, important publications have demonstrated the established role of anesthesiologists in managing perioperative anemia. A substantial pillar for anemia treatment is the implementation of Patient Blood Management worldwide.
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Simmons JW. Preoperative Intravenous Iron to Enhance a Blood Management Program. Anesth Analg 2018; 127:1101-1103. [DOI: 10.1213/ane.0000000000003669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wittkamp C, Traeger L, Ellermann I, Eveslage M, Steinbicker AU. Hepcidin as a potential predictor for preoperative anemia treatment with intravenous iron-A retrospective pilot study. PLoS One 2018; 13:e0201153. [PMID: 30089125 PMCID: PMC6082514 DOI: 10.1371/journal.pone.0201153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/08/2018] [Indexed: 12/14/2022] Open
Abstract
Preoperative anemia occurs in about one third of patients who undergo elective surgery and is associated with an impaired outcome. Therefore, screening of preoperative anemia was established in the context of a multidisciplinary Patient Blood Management (PBM) program at the University Hospital of Muenster, Germany. Anemic patients without contraindications were treated with intravenous (IV) iron (ferric carboxymaltose) to increase their hemoglobin (Hgb) levels and hence to treat anemia prior to surgery. Interestingly, we detected a large variability in the response of Hgb levels after IV iron administration. Systemic iron homeostasis is mainly regulated by the hepatic hormone hepcidin, which regulates the cell surface expression of the sole known iron exporter ferroportin. The objective of this retrospective pilot study was to analyze the potential of hepcidin to predict the response of anemic patients to preoperative IV iron treatment measured as increase in Hgb. Serum samples of non-anemic (n = 48), untreated anemic (n = 64) and anemic patients treated with IV iron (n = 79), in total 191 patients, were collected between October 2014 until June 2016. Serum hepcidin levels were determined and data were analyzed retrospectively. The analysis revealed at first a correlation between serum hepcidin levels and the parameters of the iron status. Second, patients treated with IV iron showed a noticeably higher increase in their delta Hgb level between PBM consultation and surgery (0.45g/dl [0.05, 1.05] compared to patients without IV iron (0.1g/dl [-0.48, 0.73], *p = 0.03). Patients were then grouped into ‘non-responders’, defined as delta Hgb <0.6g/dl and ‘responders’, with delta Hgb ≥0.6g/dl between the day of IV iron treatment and the day of surgery. Within normal ranges and clinically unapparent, a statistically noticeable difference between responders and non-responders was found for CRP and leukocytes. Serum hepcidin levels were higher in the group of non-responders (10.6ng/ml [3.93, 34.77]) compared to responders (2.1ng/ml [0.25, 7.97], *p = 0.04). To conclude, the data of this retrospective pilot study indicate that hepcidin might be a promising biomarker to predict a patient`s responsiveness to IV iron in preoperative anemia treatment. Prospective studies have to investigate serum hepcidin levels as a biomarker to guide physician`s decision on IV iron substitution.
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Affiliation(s)
- Christina Wittkamp
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Lisa Traeger
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Ines Ellermann
- Department of Pharmacy, University Hospital Muenster, University of Muenster, Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Andrea U. Steinbicker
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany
- * E-mail:
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