Anaemia is common in patients undergoing major abdominal surgery and only a few patients receive appropriate management or follow‐up, Australian researchers have found.
And with study results also confirming that anaemia is linked to poor post-operative outcomes, researchers say their results highlight the need for consistent adherence to consensus guidelines on the identification and management of peri‐operative anaemia.
Published in the MJA (link here) the results come from the POST‐operative Variability in anaemia treatmenT and Transfusion (POSTVenTT) Study Collaborative group, which obtained data from 2730 patients who underwent surgery at 56 hospitals in Australia and New Zealand in 2021.
Haemoglobin levels obtained prior to surgery showed that 28% of patients had anaemia. Pre‐operative anaemia assessment and management were associated with lower likelihood of intra‐operative (adjusted odds ratio [aOR], 0.33; 95% CI, 0.19–0.57) and post‐operative blood transfusion (aOR, 0.36; 95% CI, 0.25–0.53), and of post‐operative complications (aOR, 0.79; 95% CI, 0.63–0.99).
Tranexamic acid was administered during 4.7% of procedures, and a restrictive transfusion strategy was followed for 58% of the 167 patients who received post‐operative blood transfusions.
Post‐operative anaemia was identified in 59.3% of 2069 patients in whom haemoglobin was assessed prior to discharge. Of the 1227 patients with anaemia at discharge, follow-up haemoglobin measurements were recorded in hospital records for 299 (24.4%), of whom 220 still had anaemia (73.6%).
Re‐admission to hospital within 30 days was twice as common for patients with anaemia at discharge than those without anaemia (14.0% v 7.4%). Only about one in four patients with post‐operative anaemia (24.3%) had haemoglobin assessments were recorded by 30 days after discharge.
The study investigators, led by Professor Toby Richards from the University of Western Australia and the Fiona Stanley Hospital in Perth said the high rates of post-operative anaemia and inconsistent management suggested that more comprehensive investigation and follow‐up of patients with anaemia is needed.
They noted that patient blood management guidelines from the Australian National Blood Authority (ANBA) recommend that anaemia be identified, evaluated, and managed prior to surgery, that tranexamic acid be administered during the procedure if blood loss sufficient to cause anaemia is anticipated, and that a restrictive post-operative blood transfusion strategy be applied, haemoglobin routinely assessed, and early oral iron administration be avoided after surgery.
They said that while haemoglobin was assessed in 90% of patients before abdominal surgery and iron studies were undertaken for 35% of those with anaemia, the pre‐operative use of intravenous iron was relatively uncommon.
The findings also reflected the lack of adoption of recommendations for peri‐operative tranexamic acid administration, they added.
“In our study sample, only 5% of patients undergoing major abdominal surgery received it, predominantly patients who also needed intra‐operative blood transfusions and those with pre‐operative anaemia,” they wrote.
Tranexamic acid was most frequently used in gynaecological and urological procedures, but recent studies have shown it reduces bleeding during non‐cardiac surgery, supporting its use for reducing peri‐operative blood loss, they said.
The authors said the use of post‐operative blood transfusions was appropriate, with 88% meeting the 2012 ANBA guidelines recommendation that transfusions be reserved for patients with haemoglobin levels below 80 g/L.
“The management of peri-operative anaemia needs to be improved to enhance surgical outcomes,” they concluded.