Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from Spain

In patients undergoing major orthopaedic surgery, pre-operative anaemia, peri-operative bleeding and a liberal transfusion policy are the main risk factors for requiring red blood cell transfusion (RBCT). The clinical and economic disadvantages of RBCT have led to the development and implementation...

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Detalles Bibliográficos
Autores: Bisbe Vives, Elvira, Basora Macaya, Misericordia, Colomina Soler, M. J. (María José)
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2017
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/113123
Acceso en línea:https://hdl.handle.net/2445/113123
Access Level:acceso abierto
Palabra clave:Cirurgia ortopèdica
Anèmia
Espanya
Dèficit de ferro
Eritropoetina
Transfusió de sang
Conservació de la sang
Orthopedic surgery
Anemia
Spain
Iron deficiency diseases
Erythropoietin
Blood transfusion
Blood preservation
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spelling Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from SpainBisbe Vives, ElviraBasora Macaya, MisericordiaColomina Soler, M. J. (María José)Cirurgia ortopèdicaAnèmiaEspanyaDèficit de ferroEritropoetinaTransfusió de sangConservació de la sangOrthopedic surgeryAnemiaSpainIron deficiency diseasesErythropoietinBlood transfusionBlood preservationIn patients undergoing major orthopaedic surgery, pre-operative anaemia, peri-operative bleeding and a liberal transfusion policy are the main risk factors for requiring red blood cell transfusion (RBCT). The clinical and economic disadvantages of RBCT have led to the development and implementation of multidisciplinary, multimodal, individualised strategies, collectively termed patient blood management, which aim to reduce RBCT and improve patients' clinical outcome and safety. Within a patient blood management programme, low pre-operative haemoglobin is one of the few modifiable risk factors for RBCT. However, a survey among Anaesthesia Departments in Spain revealed that, although pre-operative assessment was performed in the vast majority of hospitals, optimisation of haemoglobin concentration was attempted in <40% of patients who may have benefitted from it, despite there being enough time prior to surgery. This indicates that haemoglobin optimisation takes planning and forethought to be implemented in an effective manner. This review, based on available clinical evidence and our experience, is intended to provide clinicians with a practical tool to optimise pre-operative haemoglobin levels, in order to minimise the risk of patients requiring RBCT. To this purpose, after reviewing the diagnostic value and limitations of available laboratory parameters, we developed an algorithm for the detection, classification and treatment of pre-operative anaemia, with a patient-tailored approach that facilitates decision-making in the pre-operative assessment. We also reviewed the efficacy of the different pharmacological options for pre-operative and post-operative management of anaemia. We consider that such an institutional pathway for anaemia management could be a viable, cost-effective strategy that is beneficial to both patients and healthcare systems.Edizioni SIMTI2017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/113123Articles publicats en revistes (Ciències Clíniques)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.2450/2017.0177-16Blood Transfusion, 2017, vol. 15, p. 296-306https://doi.org/10.2450/2017.0177-16(c) Edizioni SIMTI, 2017info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1131232026-05-27T06:46:51Z
dc.title.none.fl_str_mv Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from Spain
title Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from Spain
spellingShingle Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from Spain
Bisbe Vives, Elvira
Cirurgia ortopèdica
Anèmia
Espanya
Dèficit de ferro
Eritropoetina
Transfusió de sang
Conservació de la sang
Orthopedic surgery
Anemia
Spain
Iron deficiency diseases
Erythropoietin
Blood transfusion
Blood preservation
title_short Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from Spain
title_full Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from Spain
title_fullStr Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from Spain
title_full_unstemmed Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from Spain
title_sort Peri-operative treatment of anaemia in major orthopaedic surgery: a practical approach from Spain
dc.creator.none.fl_str_mv Bisbe Vives, Elvira
Basora Macaya, Misericordia
Colomina Soler, M. J. (María José)
author Bisbe Vives, Elvira
author_facet Bisbe Vives, Elvira
Basora Macaya, Misericordia
Colomina Soler, M. J. (María José)
author_role author
author2 Basora Macaya, Misericordia
Colomina Soler, M. J. (María José)
author2_role author
author
dc.subject.none.fl_str_mv Cirurgia ortopèdica
Anèmia
Espanya
Dèficit de ferro
Eritropoetina
Transfusió de sang
Conservació de la sang
Orthopedic surgery
Anemia
Spain
Iron deficiency diseases
Erythropoietin
Blood transfusion
Blood preservation
topic Cirurgia ortopèdica
Anèmia
Espanya
Dèficit de ferro
Eritropoetina
Transfusió de sang
Conservació de la sang
Orthopedic surgery
Anemia
Spain
Iron deficiency diseases
Erythropoietin
Blood transfusion
Blood preservation
description In patients undergoing major orthopaedic surgery, pre-operative anaemia, peri-operative bleeding and a liberal transfusion policy are the main risk factors for requiring red blood cell transfusion (RBCT). The clinical and economic disadvantages of RBCT have led to the development and implementation of multidisciplinary, multimodal, individualised strategies, collectively termed patient blood management, which aim to reduce RBCT and improve patients' clinical outcome and safety. Within a patient blood management programme, low pre-operative haemoglobin is one of the few modifiable risk factors for RBCT. However, a survey among Anaesthesia Departments in Spain revealed that, although pre-operative assessment was performed in the vast majority of hospitals, optimisation of haemoglobin concentration was attempted in <40% of patients who may have benefitted from it, despite there being enough time prior to surgery. This indicates that haemoglobin optimisation takes planning and forethought to be implemented in an effective manner. This review, based on available clinical evidence and our experience, is intended to provide clinicians with a practical tool to optimise pre-operative haemoglobin levels, in order to minimise the risk of patients requiring RBCT. To this purpose, after reviewing the diagnostic value and limitations of available laboratory parameters, we developed an algorithm for the detection, classification and treatment of pre-operative anaemia, with a patient-tailored approach that facilitates decision-making in the pre-operative assessment. We also reviewed the efficacy of the different pharmacological options for pre-operative and post-operative management of anaemia. We consider that such an institutional pathway for anaemia management could be a viable, cost-effective strategy that is beneficial to both patients and healthcare systems.
publishDate 2017
dc.date.none.fl_str_mv 2017
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/113123
url https://hdl.handle.net/2445/113123
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.2450/2017.0177-16
Blood Transfusion, 2017, vol. 15, p. 296-306
https://doi.org/10.2450/2017.0177-16
dc.rights.none.fl_str_mv (c) Edizioni SIMTI, 2017
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) Edizioni SIMTI, 2017
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Edizioni SIMTI
publisher.none.fl_str_mv Edizioni SIMTI
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.301629

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