Zwiep Terry M, Gilbert Richard W D, Moloo Husein, Touchie Donna, Martel Guillaume, Wallace Tom, Bertens Kimberly A
1Department of Surgery, London Health Sciences Centre, London, Canada.
2Department of Surgery, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, ON K1H 8 L6 Canada.
Patient Saf Surg. 2020 Apr 24;14:18. doi: 10.1186/s13037-020-00239-5. eCollection 2020.
Pre-operative anemia is a common, but treatable, condition encountered by surgical patients. It has been associated with increased perioperative complications, length of stay, and blood transfusions. The aim of this project was to increase the treatment rate of pre-operative anemia to 75% of patients consented for major hepato-pancreato-biliary (HPB) surgery.
This was an interrupted time series study and a spread initiative from a similar project in a colorectal surgery population. Interventions included an anemia screening and treatment algorithm, standardized blood work, referral to a patient blood management program, and standardized oral iron prescriptions. The primary outcome measure was the change in pre-operative anemia treatment rate and the secondary outcome measure was the post treatment increase in hemoglobin.
A total of 208 patients were included ( = 124 pre-intervention and = 84 post-intervention). Anemia was present in 39.9% of patients. The treatment rate of pre-operative anemia increased to 44.1% from 28.6%. The mean hemoglobin increased from 110 g/L to 119 g/L in patients who were treated ( = 0.03). There was no significant increase or decrease in blood transfusions or mean number of red cell units transfused per patient. Screening rates for pre-operative anemia increased from 41.1 to 64.3% and appropriate referrals to the patient blood management program increased from 14.3 to 67.6%.
This study demonstrates a small scale spread initiative focused on the treatment of pre-operative anemia. Although the goal to treat 75% of anemic patients was not reached, an effective referral pathway to an existing patient blood management program was developed, and a significant increase in the mean hemoglobin in anemic patients who have been treated pre-operatively was demonstrated.
术前贫血是外科手术患者常见但可治疗的病症。它与围手术期并发症增加、住院时间延长和输血有关。本项目的目的是将术前贫血的治疗率提高到同意接受大型肝胰胆（HPB）手术患者的75%。
这是一项中断时间序列研究，也是一项来自结直肠手术人群类似项目的推广举措。干预措施包括贫血筛查和治疗算法、标准化血液检查、转诊至患者血液管理项目以及标准化口服铁剂处方。主要结局指标是术前贫血治疗率的变化，次要结局指标是治疗后血红蛋白的增加。
共纳入208例患者（干预前n = 124例，干预后n = 84例）。39.9% 的患者存在贫血。术前贫血的治疗率从28.6% 提高到了44.1%。接受治疗的患者平均血红蛋白从110 g/L 增至119 g/L（P = 0.03）。输血或每位患者输注红细胞单位的平均数没有显著增加或减少。术前贫血的筛查率从41.1% 提高到64.3%，向患者血液管理项目的适当转诊率从14.3% 提高到67.6%。
本研究展示了一项专注于术前贫血治疗的小规模推广举措。尽管未达到治疗75% 贫血患者的目标，但开发了一条有效的转诊途径至现有的患者血液管理项目，并且证明了术前接受治疗的贫血患者平均血红蛋白有显著增加。
