'Fit to fly': overcoming barriers to preoperative haemoglobin optimization in surgical patients

被引:165
作者
Munoz, M. [1 ]
Gomez-Ramirez, S. [3 ]
Kozek-Langeneker, S. [4 ]
Shander, A. [5 ]
Richards, T. [6 ]
Pavia, J. [2 ]
Kehlet, H. [7 ,8 ]
Acheson, A. G. [9 ]
Evans, C. [10 ]
Raobaikady, R. [11 ]
Javidroozi, M. [5 ]
Auerbach, M. [12 ]
机构
[1] Univ Malaga, Sch Med, Perioperat Transfus Med, Malaga, Spain
[2] Univ Malaga, Sch Med, Dept Pharmacol, Malaga, Spain
[3] Xanit Int Hosp, Internal Med, Benalmadena, Spain
[4] Evangel Hosp, Anaesthesiol & Intens Care, Vienna, Austria
[5] Englewood Hosp & Med Ctr, Anaesthesiol Crit Care & Hyperbar Med, Englewood, NJ USA
[6] UCL, Div Surg & Intervent Sci, London, England
[7] Univ Copenhagen, Rigshosp, Sect Surg Pathophysiol, DK-2100 Copenhagen, Denmark
[8] Lundbeck Fdn Ctr Fast Track Hip & Knee Arthroplas, Copenhagen, Denmark
[9] Queens Med Ctr, Biomed Res Unit, Nottingham Digest Dis Ctr NIHR, Div Gastrointestinal Surg, Nottingham NG7 2UH, England
[10] Cardiff & Vale Univ Hlth Board, Dept Anaesthesiol, Cardiff, Wales
[11] Royal Marsden NHS Fdn Trust, Dept Anaesthesiol, London, England
[12] Georgetown Univ, Sch Med, Dept Haemat Oncol, Washington, DC USA
关键词
blood; erythrocytes; transfusion; surgery; preoperative period; RECOMBINANT-HUMAN-ERYTHROPOIETIN; BLOOD-CELL TRANSFUSIONS; INTRAVENOUS IRON; ORTHOPEDIC-SURGERY; EPOETIN-ALPHA; POSTOPERATIVE OUTCOMES; FERRIC CARBOXYMALTOSE; CONSENSUS STATEMENT; NONCARDIAC SURGERY; HIP-ARTHROPLASTY;
D O I
10.1093/bja/aev165
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
In major surgery, the implementation of multidisciplinary, multimodal and individualized strategies, collectively termed Patient Blood Management, aims to identify modifiable risks and optimise patients' own physiology with the ultimate goal of improving outcomes. Among the various strategies utilized in Patient Blood Management, timely detection and management of preoperative anaemia is most important, as it is in itself a risk factor for worse clinical outcome, but also one of the strongest predisposing factors for perioperative allogeneic blood transfusion, which in turn increases postoperative morbidity, mortality and costs. However, preoperative anaemia is still frequently ignored, with indiscriminate allogeneic blood transfusion used as a 'quick fix'. Consistent with reported evidence from other medical specialties, this imprudent practice continues to be endorsed by non-evidence based misconceptions, which constitute serious barriers for a wider implementation of preoperative haemoglobin optimisation. We have reviewed a number of these misconceptions, which we unanimously consider should be promptly abandoned by health care providers and replaced by evidence-based strategies such as detection, diagnosis and proper treatment of preoperative anaemia. We believe that this approach to preoperative anaemia management may be a viable, cost-effective strategy that is beneficial both for patients, with improved clinical outcomes, and for health systems, with more efficient use of finite health care resources.
引用
收藏
页码:15 / 24
页数:10
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