TY - JOUR
T1 - The management of peri-operative anaemia in patients undergoing major abdominal surgery in Australia and New Zealand: a prospective cohort study
AU - Collaborative, The POSTVenTT Study
AU - Wells, Cameron I.
AU - Varghese, Chris
AU - Moss, Jana-Lee
AU - Seto, Joel
AU - Daruwalla, Jurstine
AU - Mansour, Laure Taher
AU - Ferguson, Liam
AU - Dudi-Venkata, Nagendra N.
AU - Badiani, Sarit S.
AU - Gelzinnis, Scott
AU - Goh, Su Kah
AU - Vo, Uyen G.
AU - Seow, Warren
AU - Xu, William
AU - Watson, David I.
AU - Pockney, Pete
AU - Wright, Deborah
AU - Richards, Toby
AU - Robb, Doug M.
AU - Mcgee, Richard
N1 - Publisher Copyright:
© 2022 The Author. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.
PY - 2022/11/7
Y1 - 2022/11/7
N2 - Objectives: To assess the prevalence and management of anaemia in patients undergoing major abdominal surgery, and the influence of guideline adherence on patient outcomes. Design: Prospective observational cohort study. Setting: 56 hospitals in Australia and New Zealand. Participants: People aged 18 years or more who underwent major abdominal surgery during two 2-week periods in July 2021. Main outcome measures: Proportions of patients managed according to Australian National Blood Authority patient blood management guidelines. Secondary outcomes: anaemia prevalence, post-operative complications, length of hospital stay, re-admission within 30 days of discharge. Results: Data were available for 2730 eligible patients (mean age, 56.7 years; SD, 17.3 years), including 1558 women (57.1%). Haemoglobin levels prior to surgery were documented for 2461 of 2727 patients (90.2%), 689 of whom had anaemia (28.0%). 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 128 of 2728 procedures (4.7%); a restrictive transfusion strategy was followed for 96 of the 167 patients who received post-operative blood transfusions (58%). Post-operative anaemia was identified in 1227 of 2069 patients (59.3%) in whom haemoglobin was assessed prior to discharge. The proportion of people re-admitted to hospital within 30 days was larger for patients with anaemia at discharge (169 of 1207 patients followed up, 14.0% v 61 of 825, 7.4%). Haemoglobin assessments were recorded by 30 days after discharge for only 288 patients with post-operative anaemia (24.3%). Conclusions: The management of peri-operative anaemia differs between hospitals in Australia and New Zealand, with consequences for patient outcomes. Patients are often discharged after surgery with anaemia, which is therefore a potential therapeutic target. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12621001517864 (retrospective).
AB - Objectives: To assess the prevalence and management of anaemia in patients undergoing major abdominal surgery, and the influence of guideline adherence on patient outcomes. Design: Prospective observational cohort study. Setting: 56 hospitals in Australia and New Zealand. Participants: People aged 18 years or more who underwent major abdominal surgery during two 2-week periods in July 2021. Main outcome measures: Proportions of patients managed according to Australian National Blood Authority patient blood management guidelines. Secondary outcomes: anaemia prevalence, post-operative complications, length of hospital stay, re-admission within 30 days of discharge. Results: Data were available for 2730 eligible patients (mean age, 56.7 years; SD, 17.3 years), including 1558 women (57.1%). Haemoglobin levels prior to surgery were documented for 2461 of 2727 patients (90.2%), 689 of whom had anaemia (28.0%). 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 128 of 2728 procedures (4.7%); a restrictive transfusion strategy was followed for 96 of the 167 patients who received post-operative blood transfusions (58%). Post-operative anaemia was identified in 1227 of 2069 patients (59.3%) in whom haemoglobin was assessed prior to discharge. The proportion of people re-admitted to hospital within 30 days was larger for patients with anaemia at discharge (169 of 1207 patients followed up, 14.0% v 61 of 825, 7.4%). Haemoglobin assessments were recorded by 30 days after discharge for only 288 patients with post-operative anaemia (24.3%). Conclusions: The management of peri-operative anaemia differs between hospitals in Australia and New Zealand, with consequences for patient outcomes. Patients are often discharged after surgery with anaemia, which is therefore a potential therapeutic target. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12621001517864 (retrospective).
UR - https://publons.com/wos-op/publon/60758940/
U2 - 10.5694/mja2.51725
DO - 10.5694/mja2.51725
M3 - Article
SN - 0025-729X
VL - 217
SP - 487
EP - 493
JO - Medical Journal of Australia
JF - Medical Journal of Australia
IS - 9
ER -