Preoperative Assessment Clinic Research Articles

164 OLDER PATIENTS AT THE PREOPERATIVE ASSESSMENT CLINIC: CHANGING THE FOCUS FROM FIT FOR SURGERY TO OPTIMISATION FOR SURGERY

Abstract Background The Pre-operative Assessment Clinic (PAC) is run by the Anaesthetic Department and assesses older patients undergoing elective orthopaedic surgery. The aim of this study was to examine how PAC currently assesses older patients and how effective it is in assessing for likelihood of postoperative complications and requirement for rehabilitation. Methods A single-centre, retrospective study that received approval from the local ethics committee. Data were collected on all patients post elective orthopaedic surgery admitted to the on-site specialist rehabilitation unit for older persons, between 1st May 2020 and 31st December 2021. Data were collected from hospital Information Technology platform, Bluespiers. Results Seventy-six patients (58 female; median age: 80 years) were included. Median time from PAC to surgery was 95 days. Functional assessment was completed in 63.16% of cases, formal cognitive assessment was done in 13% of cases. Number of falls in the preceding year was recorded in 31% of patients. Baseline mobility was recorded in 93% of cases. Whilst smoking and alcohol history was recorded in 96% of cases, number of units was not calculated. 45% (n=34) of patients were correctly identified as likely to require post-operative inpatient rehabilitation. PAC did not record sarcopaenia, polypharmacy or delirium risk factors. From our dataset, at least 13% had sarcopaenia, 80% had polypharmacy and 23% required opiate medications. Post-operatively, 16% of patients developed a delirium and 12% had an acute kidney injury. Conclusion In its current format, PAC fails to optimally risk stratify frail, older patients. Attention concentrates on fitness for surgery rather than optimisation of patients. Failure to record frailty, sarcopenia, cognitive impairment and risk factors for delirium is leading to missed opportunities in terms of delirium prevention, and peri-operative optimisation of older patients as well as discharge planning before surgery. Collaboration with specialist geriatric services at PAC should improve patient outcomes.

248 BENEFITS OF POST-OPERATIVE SPECIALIST GERIATRIC CARE FOR OLDER PATIENTS UNDERGOING ELECTIVE ORTHOPAEDIC SURGERY

Abstract Background The Covid-19 pandemic changed work practices across many different healthcare institutions. The difficulties with cross-site transfers created an opportunity in our institution to provide on-site post-operative rehabilitation for older patients undergoing elective orthopaedic surgery. The aim of this study is to assess the impact of post-operative specialist geriatric care on older patients. Methods This is a single-centre, retrospective study that received approval from the local hospital ethics committee. Data were collected on all patients admitted to the on-site specialist rehabilitation unit post-elective orthopaedic surgery between 1st May 2020 and 31st December 2021. Two patients in this group were excluded as they had not attended a pre-operative assessment clinic. Data were collected from hospital Information Technology platform, Bluespiers. Results 76 patients, 18 males and 58 females, were included in this study. The median age was 80 years. In the specialist rehabilitation unit, evidence of cognitive impairment was established in 40.79% of cases, there were 3 cases of newly diagnosed dementia, a history of falls was identified in 32.89% of patients and 13.16% of patients were found to have sarcopaenia. The median length of stay in the rehabilitation unit was 25 days. 51.32% of patients were discharged home independently, 23.68% of patients went home with a new Home-Care Package (HCP), 15.79% of patients were discharged home with an existing HCP, 6.58% of patients were transferred for further treatment and 2.63% patients were discharged to residential care units. Conclusion This data demonstrates a clear role for specialist geriatric care in elective rehabilitation, with a significant proportion of patients being discharged home independently. The benefits of a comprehensive geriatric assessment in the peri-operative setting include increased identification of cognitive impairment allowing appropriate implementation of brain health as well as identification of a history of falls, enabling falls risk assessment and management including bone health assessment.

Challenge of individualised risk assessment in a tertiary hospital

Background: Individualised risk assessment is vital to inform shared decision-making and to enable appropriate perioperative care.1 Our 2018–19 Perioperative Quality Improvement Project (PQIP) site report highlighted only 54.5% of patients at our hospital were being appropriately risk assessed in preoperative assessment clinics (POACs), lower than the national average of 65%.2 We conducted a local audit in 2020 and our data agreed with the findings of the report. After this we developed teaching sessions to aid pre-assessment nurses with risk stratification.

Development, implementation and evaluation of high-quality virtual preoperative anaesthetic assessment during COVID-19 and beyond: a quality improvement report

BackgroundPreoperative risk factor identification and optimisation are widely accepted as the gold standard of care for elective surgery and are essential for reducing morbidity and mortality. COVID-19 public health restrictions...

Preparing patients for surgery: Perioperative care and general practice

Perioperative care challenges the integration of community and hospital multidisciplinary teams to prepare patients for surgery from the moment a patient considers undergoing an operation to the later recovery from surgery. Primary care has a role in the perioperative pathway, for example, in the management of long-term conditions and in identifying treatable pathology ahead of surgery. There are many factors beyond the control of primary care that compromise the optimisation of patients’ long-term conditions or even their general health ahead of planned surgery. However, there may be opportunities to optimise patients’ relevant comorbidities when surgery is first contemplated during the increasingly protracted period before surgery. Preoperative assessment clinics (POACs) are integral to perioperative care and present an opportunity to address specific issues relating to the day of surgery and to answer patients’ questions. Often POACs see patients with long-term conditions not optimised for surgery. This is a late, and less than ideal, opportunity to prepare patients for surgery. This article seeks to identify earlier opportunities to effectively improve the preparation of patients for surgery and to avoid postponement of surgery.

668 Introduction of a Pre-Operative Assessment Clinic for Elective Procedures in a Renal Replacement Therapy Unit - Analysis of Effect on Cancellation of Procedures

Abstract Aim In September 2020, our Renal and Transplant unit introduced a new formalised protocol for Pre-Operative Assessment Clinics (POACs), led by SHO-grade junior doctors. This study aims to investigate the efficacy of the new protocol. Method All elective operations including dialysis access procedures, transplant urology, parathyroidectomies and hernia repairs conducted by a single renal replacement therapy unit were examined over an 18-month period prior to POAC implementation, then a 12-month period following implementation. Living donor transplants and nephrectomies were excluded. On-the day (OTD) cancellation causes were analysed and categorised into: Results Total cases performed: Pre-implementation = 921, post-implementation = 415. OTD cancellations: Pre-implementation - total of 211/921 (22.9%). 90 (9.8%) were due to predictable patient factors, 54 (5.9%) for unpredictable patient factors and 67 (7.2%) for hospital factors. Post-implementation - total of 58/415 (11.6%). 32 (7.7%) for unpredictable patient factors and 12 (2.9%) for hospital factors. Four (1%) were cancelled for predictable patient factors, two due to patients presenting with hypertension. Conclusions Patients with renal failure have multiple co-morbidities. Optimising pre-operative care is crucial to ensure they receive timely treatment. This audit has demonstrated that a redesigned POAC led to a reduction of OTD cancellation rates from 22.9% to 11.6%, with a marked reduction in predictable causes for cancellations. Further improvements and re-audit are planned.

WE4.2 Audit of pre-operative blood tests for Elective General Surgery at Northampton General Hospital

Abstract Aim Annually 9.9 million people undergo elective surgery in the NHS. The National Institute of Health and Care Excellence (NICE) published guidelines on ‘Routine pre-operative tests in elective surgery’ in 2016. It aimed to reduce unnecessary testing by taking into account patient comorbidities and the complexity of surgery. Excessive testing can cause significant anxiety in patients, delays in treatment and exposure to COVID caused by unnecessary hospital visits. Additionally, unnecessary blood tests can exacerbate blood bottle shortages. We are auditing the compliance of NICE guidelines when requesting blood tests for elective general surgical patients in pre-operative assessment clinics at Northampton General Hospital (NGH) Method The audit team at NGH provided details of the first 64 patients undergoing elective general surgery (categorised into 22 Minor, 23 Intermediate, 19 Major procedures), from May to July 2021. Electronic records were used to determine patient ASA grades and blood tests requested at pre-operative assessment clinics. These were checked against NICE (2016) guidelines. Results Conclusion There is poor compliance with NICE guidelines. NGH Anaesthetic team have implemented changes in November 2021, as part of MyPreOP online app, to ensure these guidelines are followed. We will re-audit in February 2022 and consider implementing changes across all surgical specialties.

Retinal small vessel dilatation in the systemic inflammatory response to surgery

Retinal microvascular calibre has been proposed as a predictor of cardiac events. Surgery is a major stimulus for inflammation which potentially affects small vessel calibre. This study examined the effects of surgery on retinal, and thus systemic, small vessel size, and the potentially confounding effect of surgery when retinal vessel calibre is used to predict cardiac risk in hospital patients. Consecutive participants were recruited from a preoperative assessment clinic at a teaching hospital. They provided demographic and clinical details, and underwent retinal imaging before and again, within 3 days after surgery, with a non-mydriatic retinal camera. Images were graded for vessel calibre using semi-automated software based on the Parr-Hubbard formula with Knudtson’s modification (IVAN, U Wisconsin). Differences were examined using Fisher’s exact test or a paired t-test, and calibre determinants identified from univariate and multiple linear regression analysis (STATA version 11.2). Sixty-eight participants (23 men, 34%) with a mean age of 55 ± 14.5 years, were recruited. Fourteen (21%) underwent a laparotomy which was considered major surgery and 54 (79%) had Other surgery. Mean C-reactive protein (CRP) levels increased post-operatively from 7.8 ± 20.2 mg/L to 43.9 ± 55.1 mg/L (p < 0.01), and mean serum albumin decreased from 38.9 ± 4.4 g/L to 33.9 ± 5.5 g/L (p < 0.01). Mean central retinal arteriole and venular equivalent calibre (CRAE, CRVE) increased post-operatively (142.4 ± 13.3 µm to 146.4 ± 13.0 µm, p < 0.01 and 213.1 ± 16.8 µm to 217.9 ± 18.3 µm, p < 0.01, respectively). The systemic microvasculature dilates post-operatively possibly secondary to inflammation and endothelial dysfunction. These changes were present within 3 days of surgery and may confound the use of small vessel calibre to predict cardiac risk in surgical inpatients. Microvascular dilatation in response to other inflammatory stimuli such as pneumonia is a known potential confounder in hospital patients.

153 The Patient Perspective on Day Case Arthroplasty

Abstract Introduction Day Case Arthroplasty has been validated as a safe strategy for reducing length of stay for patients undergoing elective arthroplasty. With the ongoing recovery of elective activities following the COVID pandemic and long waiting lists; day case arthroplasty offers a solution for both hospitals and patients. Reducing length of stay will reduce the cost of day case arthroplasty which benefits hospitals, whilst the faster discharge reduces unnecessary exposure to an increased risk of COVID for patients. This study aims to establish the patient perspective on day case arthroplasty to inform the set-up of a patient cantered day case arthroplasty service. Method Data was collected at routine preoperative assessment clinics via a structured questionnaire which combined both quantitative and qualitative methods. The questionnaire covered patient demographics, issues pertaining to same-day discharge, level of concern related to common problems faced by patients after joint replacement surgery and patient preference for same day discharge versus more traditional rehabilitation methods. Results The study included 79 patients with 43% preferring same day discharge. Postoperative pain, surgical complications and wound healing were the most significant concerns elicited. Patients who preferred same day discharge were statistically younger. The majority of patients felt that their rehabilitation could be completed at home. Conclusions The results of this study highlight the demand for day case arthroplasty in this cohort of patients with younger patients preferring same day discharge. Identifying significant concerns will be important to formulate effective perioperative protocols to ensure successful implementation of a patient cantered day case arthroplasty service.

Utility and reliability of the Clinical Frailty Scale in patients scheduled for major vascular surgery: a prospective, observational, multicentre observer-blinded study

BackgroundFrailty is a distinctive health state associated with a loss of physiological reserve that results in higher rates of perioperative complications and impaired return to pre-morbid functional status. It is prevalent in the vascular population; however routine assessment is not common despite national guidance to the contrary. We aimed to evaluate the reliability of the Clinical Frailty Scale in assessing frailty in the surgical vascular population.MethodsIn this prospective, observational, observer-blinded study, we compared assessment of frailty in patients scheduled for major vascular surgery attending the pre-operative assessment clinic using the Clinical Frailty Scale against the Edmonton Frailty Scale.The study investigator completed the Edmonton Frailty Scale assessment; this was compared to the Clinical Frailty Scale assessments performed by the pre-assessment consultant and pre-assessment nurse, who were blinded to the Edmonton Frailty Scale score. The inter-rater reliability of the Clinical Frailty Scale between the pre-assessment consultant and pre-assessment nurse was determined by comparing their frailty scores for each patient.ResultsNinety-seven patients were included in the analysis (median age 72 years, 84% male and 16% female). There was a moderate level of agreement between the Edmonton and Clinical Frailty Scale score for both consultants (87.6% agreement) and pre-assessment nurses (87.6% agreement). There was a substantial level of agreement between consultants and pre-assessment nurses for the Clinical Frailty Scale (89.7% agreement)ConclusionsThe Clinical Frailty Scale is a useful tool to assess frailty in the vascular surgical population. It is more practical than the Edmonton Frailty Scale: quick to complete, requires minimal training and can be used when physical disability is present.Trial registrationThe study was approved by the Wales Health and Care Research Ethics Service (REC reference 17/WA/0160, IRAS 201173). Trial registration: NCT03403673. Registered 19 January 2018, https://clinicaltrials.gov/ct2/show/NCT03403673

2021 Canadian Surgery Forum: Virtual, online Sept. 21-24, 2021.

# 01. Design and validation of a unique endoscopy simulator using a commercial video game {#article-title-2} Procedural simulation has been shown to enhance early endoscopy training. In this proof of concept study, we aimed to show that a first-person shooter (FPS) video game with a novel in-house

696 Are Group and Save Samples Necessary for Common Urological Procedures?

Abstract Aim Blood tests are routinely performed as a part of pre-operative assessment (pre-op). We looked at the number of group and save (G+S) samples taken at pre-op and compared that to the number of patients needing blood transfusion having undergone common Urological procedures at our hospital. Our objective was to assess the utility of this invasive procedure in this clinical setting. Method Data was retrospectively collected from electronic patient records on 413 patients undergoing elective urological procedures 1st June 2020 to 30th September 2020 at Colchester General Hospital. Major procedures like radical prostatectomies, nephrectomies were excluded. Patients who had G+S samples done prior to surgery were checked. This was compared to the patients who required transfusions. Results Amongst 413 patients who underwent an elective urological procedure, 169(41%) were day-case endoscopic, 151(37%) were inpatient, and 93(22%) were penoscrotal procedures. 104(25%) patients had G+S taken, with only 5 patients (1.2%) requiring transfusion. 24(14.2%) patients undergoing day case procedures,79(52.3%) patients undergoing inpatient procedures and 1(1.1%) patient undergoing penoscrotal procedures had G+S tests done. Only 7(1.7%) patients had a baseline haemoglobin of less than 100. Conclusions Our data showed that many G+S samples were unnecessary. TURBTs (transurethral resection of bladder tumours) were most likely to need transfusion. Education was fed-back to those running pre-operative assessment clinics that G+S should be considered for TURBTs and those with Hb &amp;lt; 100. We recommend running this audit again to further quantify the G+S tests which could be avoided.

Preoperative assessment clinics and case cancellations: a prospective study from a large medical center in China.

BackgroundPreoperative assessment clinics have great benefits in reducing surgical cancellations, saving hospital resources and improving patient satisfaction. However, previous studies did not focus on patients with comorbidities. With advancements in medicine and aging population, the number of elderly patients with multiple comorbidities is increasing. This study was designed to assess the effectiveness of a preoperative assessment clinic for patients with multiple comorbidities.MethodsThis prospective, observational study enrolled patients with multiple comorbidities from Nov 1, 2019 to Oct 31, 2020 in a tertiary teaching hospital in China. Patients either visited the preoperative assessment clinic before admission or received an anesthesia consultation after admission. The impact of clinic visits on operating room cancellations, length of hospital stay before surgery, length of hospital stay after surgery, major postoperative complications, incidence of postoperative intensive care unit (ICU) admission, readmission to any hospital within 30 days after surgeries and total in-hospital costs were analyzed.ResultsA total of 326 eligible cases were included. Eighty-seven of 108 cases who visited the clinic before admission were scheduled for selective surgeries. In all, 218 patients received an anesthesia consultation after admission. The cancellation rate in the inpatient group was 7.80%, while no surgeries were cancelled in preclinic group (P=0.016). A preoperative assessment clinic visit statistically decreased the length of in-hospital stays before surgery from 93.02 to 76.11 h (P=0.010). After propensity score matching, significant differences in operating room cancellations (0 vs. 6.48%; P=0.015) and length of stay before surgery (76.11 vs. 92.22 h; P=0.038) persisted between two groups. No significant differences between the two groups were found in terms of prognosis, including major postoperative complications, incidence of postoperative ICU admissions, and readmissions to any hospital within 30 days (P>0.05).ConclusionsAmong patients with comorbidities undergoing major surgeries, a preoperative assessment clinic visit was more efficient than an anesthesia consultation after admission. These findings may provide impetus for the opening of preoperative assessment clinics for critical patients in China.

CORRELATION BETWEEN PREOPERATIVE ELECTROCARDIOGRAM FINDINGS AND NT-PROBNP AND POSTOPERATIVE CARDIAC EVENTS AFTER NONCARDIAC SURGERY

<h3>BACKGROUND</h3> Preoperative electrocardiogram (ECG) are routinely ordered in adults undergoing noncardiac surgery, yet ECG abnormalities have not been found to predict postoperative cardiac complications. Abnormal ECG findings may lead to unnecessary preoperative medical consultation and cardiac imaging. Preoperative NT-proBNP has been shown to enhance cardiac risk prediction and has not been compared to ECG. <h3>METHODS AND RESULTS</h3> We included a consecutive sample of 1000 patients seen at the preoperative assessment clinic prior to elective noncardiac surgery at a single tertiary-care centre. Eligible patients were either 65 years or older, or 45 to 64 years with at least one risk factor according to the Revised Cardiac Risk Index (RCRI). Mean age was 67.3 years (standard deviation 9.5), 53.7% were male, 52.6% had hypertension, 23.7% diabetes, and 13.6% prior history of coronary artery disease. Two thirds (63.1%) underwent surgery with overnight stay, the remainder had same-day surgery. The majority (97.1%) of patients had a preoperative ECG ordered, of which 51.2% had at least one abnormal ECG finding. The most common abnormal ECG findings as reported by the automated ECG interpretation were supraventricular arrythmias (181/971; 18.6%), non-specific ST-T waves abnormalities (99/971; 10.2%) and previous myocardial infarction (134/971; 13.8%). Following the abnormal ECG findings, 8.0% (95% confidence interval [CI] 6.0%-10.8%) of patients had a preoperative medical consultation or cardiac imaging ordered. Routine preoperative NT-proBNP was obtained in 29.3% (293/1000), of which 34.8% (102/293) had NT-proBNP ≥200 ng/L. For patients who underwent inpatient surgery (n=631), the 30-day incidence of major cardiac complications was 5.9% (95% CI 4.3%-8.0%). No ECG finding was associated with postoperative cardiac events, alone or in combination. A preoperative ECG finding of partial or complete left bundle branch block and supraventricular arrythmia had a weak correlation with preoperative NT-proBNP ≥200 ng/L (Pearson's R 0.185 p=0.003 and 0.202 p=0.001, respectively). In patients who had a preoperative NT-proBNP measured and underwent in-hospital surgery, NT-proBNP ≥200 ng/L was independently associated with postoperative major cardiac events (adjusted odds ratio 6.68, 95% CI 2.22-19.56). <h3>CONCLUSION</h3> In patients undergoing elective noncardiac surgery, abnormal findings were common on routine ECG and led to medical consultation or cardiac imaging in 1 in 12 patients. Abnormal ECG findings were not associated with postoperative cardiac events but preoperative NT-proBNP was a strong predictor of cardiac complications. Clinicians may consider using NT-proBNP for preoperative cardiac risk stratification in patients with abnormal ECG findings to identify patients at higher risk.

Variation in preoperative stress testing by patient, physician and surgical type: a cohort study

ObjectivesTo describe variation in and drivers of contemporary preoperative cardiac stress testing.SettingA dedicated preoperative risk assessment and optimisation clinic at a large integrated medical centre from 2008 through 2018.ParticipantsA cohort...

CORR Insights®: Does a Prescription-based Comorbidity Index Correlate with the American Society of Anesthesiologists Physical Status Score and Mortality After Joint Arthroplasty? A Registry Study.

CORR Insights®: Does a Prescription-based Comorbidity Index Correlate with the American Society of Anesthesiologists Physical Status Score and Mortality After Joint Arthroplasty? A Registry Study.

Smoking Characteristics and Readiness-to-Quit Status Among Smokers Attending Preoperative Assessment Clinic - A Prospective Cohort Study.

BackgroundPerioperative smoking is associated with an increased incidence of general postoperative morbidity and mortality. The perioperative period is recognized as an important “teachable moment” that can motivate patients to adopt health changing behaviors.ObjectiveIn this study, we aimed to determine the prevalence of smokers among elective surgical patients in an Asian tertiary hospital. We also investigated their smoking characteristics, previous quitting attempts, readiness-to-quit status as well as knowledge of smoking-related postoperative complications.MethodsWe conducted a single-center prospective cohort study among all patients who attended a preoperative assessment clinic within a 2-month period (August to September 2020) using a preoperative smoking questionnaire.ResultsA total of 3362 patients participated in the study, of which 348 (10.4%) were current smokers. More than half (65.6%) of the smokers had previously attempted to quit smoking, with most (78%) having made more than one attempt. Forty-nine percent of current smokers were in the pre-contemplation stage of quitting and thirty-one percent were in the contemplation stage. Only twenty-one percent were in the preparation stage of quitting. Thirty-eight percent of patients recognized the importance of smoking cessation perioperatively but only twenty-eight percent were confident of quitting perioperatively. Less than sixty percent of smokers were aware of at least one type of smoking-related postoperative complication. Less than half of the patients (45%) had ever received advice on perioperative smoking cessation from the surgeons.ConclusionA thorough understanding of smokers’ smoking characteristics, barriers to quit and readiness-to-quit status are crucial to establishing a successful multidisciplinary perioperative smoking cessation program. Counselling should address knowledge deficits and be tailored to a patient’s stage-of-change in order to seize this precious perioperative “teachable moment”.

Preoperative patient blood management during the SARS-CoV-2 pandemic.

Preoperative patient blood management during the SARS-CoV-2 pandemic.

P94 Pre-Operative Fasting in Surgical Patients at Good Hope Hospital – Reducing incidents of unnecessary prolonged fasting periods in patients undergoing surgery

Patients are often fasted from food and liquid for unnecessarily long periods of time prior to surgery. There is often misunderstanding amongst patients and even members of staff as to what exactly is meant by the pre-operative fasting rules, specifically the meaning of ‘clear fluids’. Prolonged fluid fasting can result in significant distress to adult and children patients through feelings of thirst, hunger and anxiety. Prolonged fasting can also negatively affect insulin resistance and severe cases of hypoglycaemia and hypovolaemia.A questionnaire was handed out to elective surgical patients over a month period between September and October 2019. Data was then collated and compared to the 2011 ESA Guidelines standard where 100% of patients should be fasted appropriately. Results were presented and a poster was created which will be distributed at pre-operative assessment clinic and displayed in clinical areas and the day-case unit.68 responses to the questionnaire were collected. The results showed that 58% of patients received both written and verbal advice about pre-operative fasting. However, 42% of patients stated they received no information about being able to drink clear fluids until 2 hours prior to their operation and therefore fasted from fluids for longer than required.In conclusion there was still disparity between what exactly was meant by ‘clear fluids’ and many did not realise the list included coffee and tea without added milk. The next steps would be to implement clear posters outlining correct fasting rules and reinforce education to healthcare staff about this matter. Patients are often fasted from food and liquid for unnecessarily long periods of time prior to surgery. There is often misunderstanding amongst patients and even members of staff as to what exactly is meant by the pre-operative fasting rules, specifically the meaning of ‘clear fluids’. Prolonged fluid fasting can result in significant distress to adult and children patients through feelings of thirst, hunger and anxiety. Prolonged fasting can also negatively affect insulin resistance and severe cases of hypoglycaemia and hypovolaemia.

Preoperative Anemia in Primary Arthroplasty Patients—Prevalence, Influence on Outcome, and the Effect of Treatment

BackgroundThis study aims to: 1) Determine the prevalence of preoperative anemia in arthroplasty; 2) Assess whether preoperative anemia is associated with inferior outcomes; and 3) Ascertain whether optimization in a dedicated blood management program (BMP) is associated with improved outcomes. MethodsAll primary arthroplasties performed at an academic, tertiary-care, arthroplasty center between 2012 and 2017 were reviewed. Hemoglobin level obtained in the preoperative assessment clinic was recorded. Patients with anemia were then considered for further review in BMP. Outcomes included improvement in hemoglobin level post-BMP; length of stay; perioperative transfusion; 90-day readmission, complication, and reoperation rates. The effect of preoperative anemia and the effect of treatment at the BMP on outcomes were evaluated through multivariable regression analysis controlling for relevant covariates. Results17% of patients (932/5384) were found to have anemia; 115/357 patients who attended the BMP were no longer anemic. Thus, at time of operation, 15% of patients (817/5384) had anemia. Anemic patients were 4.09 times more likely (95% CI: 2.64-6.35) to require a transfusion; 1.42 times more likely (95% CI: 0.99-2.03) to sustain complications and had 19% longer (95% CI: 13%-26%) length of stay.Those who attended the BMP were less likely to receive a transfusion (OR = 0.32, 95% CI: 0.16-0.66), suffer from postoperative complications (OR = 0.30, 95% CI: 0.14-0.63), or require readmission compared with anemic patients not seen in the BMP (OR = 0.25, 95% CI: 0.09-0.71). ConclusionsThe prevalence of anemia in this arthroplasty cohort was 15%. Preoperative, timely, optimization of anemia should be strongly considered as it is likely to reduce “anemia-associated burden” after arthroplasty.