Current concepts in evaluation and management of preoperative anaemia in patients undergoing thoracic surgery

Abstract

Purpose of reviewThe purpose of this review is to evaluate the current recommendations for management of perioperative anaemia in patients undergoing thoracic surgery, present the impact of anaemia on outcomes in this patient population and suggest an algorithm for evaluating and treating anaemia preoperatively. Recent findingsAnaemia is a common medical issue noted preoperatively in patients presenting for thoracic surgery and carries significant morbidity. Preoperative anaemia increases the likelihood of receiving a perioperative transfusion, which represents a significant risk factor for morbidity and reduced disease-free survival in lung cancer patients presenting for thoracic surgery. It is also associated with longer hospital lengths of stay and increased risk for reoperation following lung transplantation. An algorithm-based approach to management of anaemia is beneficial and treatment with iron has been shown to reduce transfusions. SummaryPatients undergoing thoracic surgery have a high incidence of preoperative anaemia that increases the risk of transfusion and postoperative morbidity. Preoperative evaluation and tailored treatment based on the underlying cause of anaemia reduces the incidence of anaemia prior to surgery and decreases transfusion rates.

Examining Bleeding Risk, Transfusion-related Complications, and Strategies to Reduce Transfusions in Lung Transplantation

“…Preoperative anemia, vitamin, and iron deficiency should be corrected preoperatively, if possible. 34,35 Although of some benefit in cardiac surgery, consideration of intravenous iron therapy to improve hemoglobin levels 36 is not well established or studied in lung transplantation. Erythropoietin has not been well studied in lung transplantation, with limitations including an unknown surgery date and cost of the drug relative to the time to clinical benefit.…”