PREOPERATIVE ANAEMIA AND BLOOD TRANSFUSION IN CARDIO-THORACIC SURGERY: A SINGLE CENTRE RETROSPECTIVE AUDIT

Abstract

Introduction Preoperative anaemia is a major risk factor for peri-operative blood transfusion, which is associated with postoperative morbidity and mortality.World Health Organisation(WHO) states that every effort should be made to optimise surgical patient's own blood volume using a patient blood management(PBM) approach as it has been shown to improve outcomes and reduce healthcare costs in a number of studies. So, this study was aimed to identify the prevalence of preoperative anaemia, evaluate the preoperative intervention program and peri-operative transfusion rates among patients undergoing cardio-thoracic surgery Methods We collected data retrospectively over a period of one month from patients who underwent cardiac and thoracic surgery in a university teaching hospital. Anaemia was defined as haemoglobin concentration below 130g/l for men and 120g/l in female. Results A total of 120 (67-Cardiac surgery,53-Thoracic surgery) adult patients undergoing cardio-thoracic surgery were included in the study. Majority of the patients (55% of cardiac surgery and 60% of thoracic surgery patients)belonged to 60-80 Age group. Pre-operative anaemia was present in 31% of cardiac patients and 35% of thoracic patients. None of the patients in the cardiac group was referred to anaemia clinic or received any iron supplements or pre-op blood transfusion. One patient in the thoracic group was referred to anaemia clinic and received IV iron. In the cardiac group, 57% of anaemic patients received blood transfusion intra-operatively and 28% postoperatively whereas only 9% of non-anaemic patients received blood transfusion intra-operatively and 2% post operatively. In the thoracic group, 10% of anaemic patients received blood transfusion intra-op and non-post op. In the non anaemic group, none received blood transfusion. Haematinics were prescribed post operatively for 60% patients in the cardiac group. Discussion Preoperative anaemia was present nearly one-third of patients (31% cardiac surgery and 35% thoracic surgery)at our centre. However, blood transfusion requirements were significantly high among cardiac surgery patients compared to thoracic surgery patients. Referral and anaemia treatment were infrequently initiated in preoperative anaemic patients. Following the audit, significant changes have been made regarding anaemia referral and optimisation of anaemia preoperatively. Repeat audit is planned in six months time to review the change in practice.