Author(s): Fawkner-Corbett J.; Gwinnutt M.
Source: Anaesthesia; Jan 2018; vol. 73 ; p. 20
Publication Date: Jan 2018
Publication Type(s): Conference Abstract
Available at Anaesthesia – from Wiley Online Library Full Collection
Abstract:Iron deficiency anaemia is an important and treatable comorbidity in patients presenting for major surgery . Pre-operative anaemia increases the chance of peri-operative blood transfusion, which in turn results in increased wound infection, length of stay, and mortality . We evaluated the peri-operative journey of patients undergoing major maxillofacial cancer surgery at a busy tertiary centre. We looked to establish the incidence of pre-operative anaemia in this group of patients, time from anaemia diagnosis to surgery, and the frequency and timing of peri-operative transfusion. Methods Data were collected retrospectively from case notes and electronic laboratory records of patients undergoing surgery from October 2015 to October 2016. Baseline (any time in the 6 months prior to surgery), pre-operative (in the week before surgery) and postoperative (first postoperative level) haemoglobin levels were recorded along with the dates for each result. Blood transfusion requirements (number of products and on which dates) were also recorded for each patient. Results Patients (female n = 52; male n = 49) varying in age from 39 to 88 years (mean 64.8) were studied. Using the WHO definition of anaemia , 8/52 (15.4%) female and 12/49 (24.5%) male patients (19.8% overall) were anaemic at baseline. This increased to 13/52 (25%) female and 17/49 (34.7%) male (29.7% overall) patients during the pre-operative interval. This interval ranged from 1-115 days (median 27 days) with 15/20 (75%) of the patients with anaemia at baseline waiting > 21 days. Twenty-eight patients received peri-operative blood transfusions, with a total of 67 red blood cell units transfused. Of the anaemic patients, 12/20 (60.0%) were transfused, compared to 15/81 (18.5%) non-anaemic patients. Anaemic patients accounted for 28 (42%) units of red cells transfused. Discussions A significant number of the patients undergoing maxillofacial surgery were anaemic, and these patients have high blood transfusion requirements. Two-thirds of patients wait greater than 3 weeks prior to surgery, which is adequate time to replenish patients’ iron stores and correct anaemia. A number of patients became anaemic while waiting for surgery, and so there may be a role for advising an iron-rich diet to all patients. This study suggests that there is a need for a pre-operative anaemia pathway to facilitate investigation and treatment of anaemia, aiming to reduce the need for, and risks associated with, blood transfusion.