Background:
Anemia is the most commonly encountered hematologic abnormality in preoperative evaluations and has been associated with major adverse outcomes in surgical procedures but often ignored during preoperative evaluation. The purpose of this study is to examine the prevalence of preoperative anemia and its relationship to postoperative transfusion requirements in patients undergoing elective joint replacement surgeries.
Methods:
We utilized the Cerner Power Insight to identify patients who had elective joint replacement surgeries in a five month period at the Keck Medical Center of USC (KMC) between 12/1/2013 to 4/31/2014. We excluded patients with chronic kidney disease on erythropoiesis stimulating agents and tracked preoperative and postoperative hemoglobin levels, markers of anemia, as well as transfusion requirements. In patients identified with hemoglobin <12 mg/dL, we reviewed preoperative evaluations to determine if anemia was recognized and addressed prior to surgery.
Results: Of 541 patients who received joint replacement surgeries during the study period, 334 had preoperative evaluations at KMC. Patients with preoperative hemoglobin level <11 mg/dL were far more likely to require packed red blood cell transfusion than patients with hemoglobin level ≥ 11 mg/dL (42% vs 5%). Of 33 patients with preoperative hemoglobin < 11 mg/dL, 8 (24%) patients were identified as having anemia in their preoperative evaluation documentation, and 3 out of these 8 patients received treatment or further evaluation prior to surgery.
Conclusions:
Our study contributes to the existing literature that preoperative anemia is common and often not addressed during preoperative evaluation. In patients undergoing joint replacement surgery, hemoglobin levels <11 mg/dL confer the highest risk for perioperative transfusion of packed red blood cells as well as other infusion products including erythropoietin and intravenous iron. Patients with preoperative hemoglobin levels of <11 mg/dL would most benefit from further evaluation, which may reduce the number of perioperative transfusions.
