Lasocki Sigismond, Krauspe Rüdiger, von Heymann Christian, Mezzacasa Anna, Chainey Suki, Spahn Donat R
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).
Eur J Anaesthesiol. 2015 Mar;32(3):160-7. doi: 10.1097/EJA.0000000000000202.
Patient blood management (PBM) can prevent preoperative anaemia, but little is known about practice in Europe.
To assess the pre and postoperative prevalence and perioperative management of anaemia in patients undergoing elective orthopaedic surgery in Europe.
An observational study; data were collected from patient records via electronic case report forms.
Seventeen centres in six European countries. Centres were stratified according to whether they had a PBM programme or not.
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].
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).
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).
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.
患者血液管理（PBM）可预防术前贫血，但欧洲的相关实践情况鲜为人知。
评估欧洲择期骨科手术患者术前和术后贫血的患病率及围手术期管理情况。
一项观察性研究；通过电子病例报告表从患者记录中收集数据。
欧洲六个国家的17个中心。根据是否有PBM项目对中心进行分层。
1534例接受择期髋关节、膝关节或脊柱大手术的患者[髋关节手术占49.9%，膝关节手术占37.2%，脊柱手术占13.0%；年龄64.0岁（范围18至80岁），女性占61.3%]。
术前（主要终点）和术后贫血的患病率[血红蛋白（Hb）<13 g/dl（男性），Hb<12 g/dl（女性）]、围手术期贫血管理、首次输血时间和输血量。数据以均值（标准差）或中位数（四分位间距）表示。
贫血患病率从术前的14.1%升至术后的85.8%。术前贫血和非贫血患者的平均Hb下降分别为1.9（1.5）和3.0（1.3）g/dl（P<0.001）。在有PBM项目的中心（n = 7）与无PBM项目的中心相比，术前贫血的发生率较低（8.0%对18.5%；P<0.001），铁状态评估更为频繁（铁蛋白评估为11.0%对2.6%，转铁蛋白饱和度评估为11.0%对0.1%；P<0.001）。34.3%的患者接受了围手术期贫血纠正（主要是输血）。术中，术前贫血患者中有14.8%接受了输血，非贫血患者中有2.8%接受了输血[每位患者的输血量：2.4（1.5）和2.2（1.4），首次术中输血的中位时间：130（88，158）对179（135，256）分钟；P<0.001]。术前贫血患者术后并发症的发生率高于非贫血患者（36.9%对22.2%；P = 0.009）。
大多数接受择期骨科手术的患者术前Hb水平正常，但术后出现贫血。术前贫血的患者术中输血风险和术后并发症发生率增加。在欧洲，诸如铁状态评估和避免输血的策略等PBM措施仍未得到充分应用。
