Determining the Prevalence of Pre-Operative Anemia in Elective Orthopedic Surgery Patients: A Quality Improvement Initiative
Todd M Barr, Jan F Silverman, Darrell J Triulzi, Mark Yazer. Allegheny General Hospital, Pittsburgh, PA; UPMC, Pittsburgh, PA; Institute of Transfusion Medicine, Pittsburgh, PA
Background: Patients undergoing elective total knee arthroplasty (TKA) or total hip arthroplasties (THA) are often highly transfused. In our hospital patients undergoing either TKA or THA are routinely crossmatched for 2 RBC units. Pre-operative anemia is a risk factor for allogeneic red blood cell (RBC) transfusion, although the prevalence of anemia in pre-operative orthopedic surgery patients is unknown. As part of a quality improvement project under the auspice of the hospital's blood management program we determined the prevalence of pre-operative anemia in elective TKA and THA patients.
Design: The OR schedules were reviewed over a 6 week period to identify elective TKA and THA patients. Elective surgery was defined as non-traumatic cases where the patients had been admitted to the hospital <24 hours before the procedure. Basic patient demographics were obtained from the hospital's electronic medical records. Anemia was defined using the WHO's criteria of <13 g/dl in adult men and <12 g/dl in non-pregnant adult women.
Results: There were 62 patients who underwent elective surgery performed by 6 different surgeons; 37 (60%) had first time or redo TKR, while 25 (40%) had first time or redo THR. The average age of the 62 patients was 64.6 (±9.6) and 33/62 (53%) were female. Overall there were 6/62 (9.7%) patients who were anemic before their surgery. The anemic patients had an average pre-operative Hb level of 10.6 (±1.2) g/dl compared to 14.2 (±1.1) g/dl amongst the non-anemic patients (p<0.0001). Of the anemic patients 4/6 (67%) received at least 1 RBC unit in the peri-operative period, compared to 8/56 (14%) of the non-anemic patients (p=0.01). The relative risk of requiring a peri-operative RBC transfusion was 8.3x (95% CI: 1.7 – 40.3), higher in the anemic patients compared to the non-anemic patients. One THA patient who was not anemic before surgery was transfused with an autologous RBC unit on the day of surgery. There was also a trend towards longer hospital length of stays (LOS) in the anemic compared to the non-anemic patients: (4.2 (1.6) days vs. 3.2 (0.99) days, respectively (p=0.12)).
Conclusions: In this small cohort, the patients who were anemic before surgery had a higher incidence of receiving a peri-operative allogeneic RBC transfusions and a trend towards longer hospital LOS. Interventions that reduce pre-operative anemia would be expected to improve patient safety by reducing the need for transfusions and decreasing LOS.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 270, Monday Afternoon