Treating Preoperative Anemia to Improve Patient Outcomes After Orthopaedic Surgery

Abstract

For patients undergoing orthopaedic surgery, preoperative risk modification and control of comorbidities can maximize safety and improve outcomes. Anemia is common among orthopaedic patients, and its prevalence increases with patient age. Although surgeons are well versed in intraoperative blood conservation, preoperative anemia treatment is often deferred to primary care physicians, who may not understand the importance of a thorough assessment and treatment. Orthopaedic surgeons should understand the causes and treatments of anemia to advocate that patients receive appropriate preoperative care. Mean corpuscular volume and reticulocyte count can help determine the cause of anemia and assess the bone marrow's ability to produce red blood cells. These values can be used to aid in diagnosis and treatment plans. Iron deficiency anemia, the most common type, is a microcytic anemia easily treated with iron supplementation. In cases of trauma, anemia can be related to acute blood loss and underlying conditions. Fracture patterns and preexisting comorbidities should be assessed. The role of intravenous iron supplementation in this setting has not been clearly shown. Patients needing urgent procedures that might involve substantial blood loss should receive transfusions if they have hemoglobin levels <8 g/dL or symptomatic anemia.

Role of single-dose intravenous iron therapy for the treatment of anaemia after orthopaedic trauma: protocol for a pilot randomised controlled trial

“…Based on previous studies, administration of IVIT improves haemoglobin levels within the first week, and normalisation is typically achieved within 3–4 weeks. 1 We anticipate that this will hold true in our IVIT cohort, with resolution of anaemia occurring around 3 months for the placebo cohort. We will evaluate for statistical difference of change in haemoglobin at all study visit timepoints with t tests.…”

“… 2 Perioperative anaemia is associated with increased hospital length of stay (LOS), need for blood transfusion, risk of surgical site infection, genitourinary and cardiovascular complications and death. 1 2 Additionally, anaemia has clinical implications in quality of life (QOL) measures and is associated with fatigue, impaired physical performance, decreased exercise capacity and mood disturbances. 3–5 The broad impact of anaemia is often underestimated by clinicians; treatment may have profound benefits to patients’ well-being.…”

“…The standard of care for perioperative anaemia in orthopaedic trauma is packed red blood cell (pRBC) transfusion; however, this has been associated with increased mortality, nosocomial infection, postoperative venous thromboembolism, multisystem organ dysfunction and acute respiratory distress syndrome. 1 6 7 Current recommendations for the treatment of anaemia in orthopaedic trauma centre on a restrictive strategy for management (ie, haemoglobin <7 g/dL for pRBC transfusion initiation) to minimise transfusion reactions while ignoring the long-term recovery effects of anaemia. A safer alternative to pRBCs is desirable because a critical number of patients do not meet this restrictive transfusion threshold and may be negatively impacted by anaemia during recovery.…”

“…Acute blood loss in orthopaedic trauma and operative fracture care contributes substantially to perioperative anaemia and functional iron deficiency. The prevalence of preoperative anaemia has been observed as up to 50% in patients undergoing surgical stabilisation for hip fractures1 2 and, unsurprisingly, up to 87% following hip fracture fixation 2. Perioperative anaemia is associated with increased hospital length of stay (LOS), need for blood transfusion, risk of surgical site infection, genitourinary and cardiovascular complications and death 1 2.…”

Preoperative Deficiency Anemia in Digital Replantation: A Marker of Disparities, Increased Length of Stay, and Hospital Cost

“…The adverse impact of deficiency anemias on postoperative outcomes has been well-documented in a variety of surgical types. 10 11 12 13 14 In digit replantation procedures, blood transfusions and low-hemoglobin levels have been shown to be poor prognostic factors and associated with higher failure rates. 15 However, currently available data does not describe the independent effect of deficiency anemias on treatment outcomes such as length of stay and total cost in the context of pre-existing comorbidities.…”