Implementation of a Short-term Treatment Protocol in Anemic Patients before Cardiac Surgery

Abstract

Background

We assessed whether implementation of an immediate preoperative treatment in anemic patients could result in fewer perioperative packed red blood cell (PRBC) transfusions and improved outcomes in a real-world setting.

Methods

From January 1, 2020, to November 31, 2022, we implemented a perioperative protocol for anemic patients (hemoglobin (Hb) level in women <11.5 g/dL, men <12.5 g/dL), which included subcutaneous erythropoietin α, intravenous Iron, and intramuscular vitamin B12 (all given preoperatively) and per os iron and folic acid given once a day postoperatively. We retrospectively compared all patients receiving the protocol to all eligible patients who were operated upon in the 4 years prior to implementation of the protocol. Primary outcome was amount of PRBC transfusions during surgery and index admission.

Results

In the months after protocol implementation, 114 patients who received the treatment protocol were compared with 236 anemic patients in the 4 years prior to who did not receive the protocol. The treatment reduced total PRBC use (control group median 4 [2–7] units vs. treatment 2 [1–3] units, p < 0.0001) and the incidence of postoperative blood products transfusions (treatment group 58 patients, 50.88% vs. control group 177 patients, 75%, p < 0.0001). Hb prior to discharge was higher among the protocol group (treatment median 9 g/dL [8.3–9.5 g/dL] vs. control 8.6 g/dL [8.1–9.1 g/dL], p = 0.0081).

Conclusion

Despite some differences compared with previously described protocols, the implementation of a perioperative treatment protocol for anemic patients was associated with a reduction in PRBC transfusion in a real-world setting.

Keywords

anesthesia - blood transfusion - coronary artery bypass graft surgery - outcomes

Authors' Contribution

Both D.B.L. and D.A. contributed equally to the conceptualization, data collection, interpretation of the results, writing and editing the manuscript. Both authors invested the same number of hours and effort in this paper.

^* These authors contributed equally.

Publication History

Received: 04 June 2023

Accepted: 12 September 2023

Accepted Manuscript online:
14 September 2023

Article published online:
30 October 2023

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