TY - JOUR
T1 - 'Fit to fly'
T2 - overcoming barriers to preoperative haemoglobin optimization in surgical patients
AU - Muñoz, M
AU - Gómez-Ramírez, S
AU - Kozek-Langeneker, S
AU - Shander, A
AU - Richards, T
AU - Pavía, J
AU - Kehlet, H
AU - Acheson, A G
AU - Evans, C
AU - Raobaikady, R
AU - Javidroozi, M
AU - Auerbach, M
N1 - © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected].
PY - 2015/7/1
Y1 - 2015/7/1
N2 - 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.
AB - 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.
KW - Anemia
KW - Blood Loss, Surgical
KW - Blood Transfusion
KW - Female
KW - Hemoglobins
KW - Humans
KW - Male
KW - Preoperative Care
KW - Risk Factors
KW - Surgical Procedures, Operative
U2 - 10.1093/bja/aev165
DO - 10.1093/bja/aev165
M3 - Journal article
C2 - 26089443
SN - 0007-0912
VL - 115
SP - 15
EP - 24
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 1
ER -