Warnakulasuriya Samantha R, Wolff Kathleen, Stanworth Simon J
Department of Anaesthesia and Perioperative Medicine, University College London Hospital NHS Foundation Trust, London, UK.
NIHR Blood and Transplant Research Unit in Data Driven Transfusion Practice (BTRU), University of Oxford, UK.
Anaesthesia. 2025 Jul;80(7):781-789. doi: 10.1111/anae.16579. Epub 2025 Mar 12.
In UK hospitals, it is unclear how organisational structures are arranged to support effective implementation of peri-operative blood management practice strategies. The aim of this study was to conduct a national survey of organisations to describe local practices of peri-operative patient blood management and infrastructure availability in the UK.
A series of benchmarking standards was developed using recommendations informed by national standards, relevant literature and an expert panel. Through the Research and Audit Federation of Trainees networks, 143 hospitals were approached to participate. The pre-piloted survey was conducted online between January and February 2023.
Responses were received from 123 hospitals across 74 NHS Trusts and health boards. Formal elective anaemia pathways were not reported in 37/123 (30%) sites. There was considerable inter-site variation in interventional thresholds for anaemia and screening tests. A variety of oral iron regimens were reported, from once-daily dosing in 41/85 (48%) sites, to three times a day dosing in 14/85 (16%). Ferric carboxymaltose was the preparation used most frequently at sites that administered intravenous iron (61/113, 54%). There was variation between hospitals and surgical specialties in the use of tranexamic acid with 49/122 (39%) hospitals reporting a policy for the use of peri-operative tranexamic acid. For sites that performed major surgery routinely (irrespective of specialty), 20/112 (18%) included tranexamic acid in operating theatre safety briefings. Point-of-care coagulation testing was available at 62/123 (50%) sites.
Our findings show considerable heterogeneity in peri-operative patient blood management strategies and supporting infrastructure availability across the UK. There is a pressing need for hospitals to review pathways of care offered to surgical patients and implement national recommendations.
在英国医院中，尚不清楚组织结构是如何安排以支持围手术期血液管理实践策略的有效实施。本研究的目的是对各机构进行全国性调查，以描述英国围手术期患者血液管理的当地实践和基础设施可用性。
利用国家标准、相关文献和专家小组的建议制定了一系列基准标准。通过研究与审计学员联合会网络，联系了143家医院参与。预试点调查于2023年1月至2月在线进行。
收到了来自74个国民保健服务信托基金和健康委员会的123家医院的回复。37/123（30%）的机构未报告正式的择期贫血治疗路径。贫血干预阈值和筛查试验存在显著的机构间差异。报告了多种口服铁剂治疗方案，从41/85（48%）的机构每日一次给药，到14/85（16%）的机构每日三次给药。羧基麦芽糖铁是静脉注射铁剂的机构中最常用的制剂（61/113，54%）。氨甲环酸的使用在医院和外科专科之间存在差异，49/122（39%）的医院报告了围手术期使用氨甲环酸的政策。对于常规进行大手术的机构（无论专科），20/112（18%）在手术室安全简报中纳入了氨甲环酸。62/123（50%）的机构提供即时凝血检测。
我们的研究结果表明，英国围手术期患者血液管理策略和支持性基础设施可用性存在相当大的异质性。医院迫切需要审查为手术患者提供的护理路径并实施国家建议。
