Preoperative anemia management clinics may reduce number of blood transfusions

SAN DIEGO — A preoperative anemia management clinic led to the reduction in the use of blood transfusions and in length of hospital stays, according to a multidisciplinary study presented at the ASH Annual Meeting and Exposition.

Preoperative anemia is a common occurrence in elective presurgical populations, with a reported incidence of 5% to 75%. Approximately 50% of all blood transfusions occur in the perioperative setting, and transfusions pose a significant financial burden for health care institutions.

Usha D. Perepu , MBBS, of the department of internal medicine at University of Iowa, and colleagues describe a novel preoperative anemia management clinic workflow and report patient volume trends since its implementation in January 2015.

Perepu and colleagues identified 3,262 patients undergoing elective high blood loss surgical procedures with a projected blood loss greater than 500 cc. All patients had a preoperative hemoglobin less than 12 gl/dl.

In 2014, 452 patients (13.9%) received perioperative red cell transfusions. Of those, 232 patients (51.3%) had a preoperative hemoglobin less than 12 gl/dl. Among those 232 patients, 61 patients (26%) were transfused one unit of perioperative red blood cells, 62 patients (27%) were transfused with two units, and the remaining 109 patients (47%) received more than two units.

Assuming transfusions of one to two units were preventable by preoperative anemia management, the estimated cost savings by avoiding these transfusions was estimated to be $200,000 per year, excluding additional savings due to shortened length of stays.

Using these data to obtain hospital administration approval, Perepu and colleagues established an outpatient clinic in a temporary location early in 2015, which was later moved to a permanent location with infusion capabilities.

A multidisciplinary team that included hematology, anesthesiology, surgery, internal medicine, nursing and pharmacy created a stepwise algorithm for diagnosis and management of anemia to streamline workflow. Researchers also established referral mechanisms from surgical clinics and outpatient consultations using automatic electric medical records alerts for elective high blood loss procedures.

Perepu and colleagues observed a reduction in the percentage of patients transfused perioperatively in the two quarters following implementation of the clinic compared with the preceding quarterly intervals.

“In the same period we observed a steady increase in the number of patient visits to the anemia management clinic and the number of iron infusions administered,” Perepu and colleagues wrote.

Researchers reported patient visits (594 vs. 195) and iron infusions (366 vs. 124) more than doubled in the first two quarters of 2016 compared with the same time period in 2015. As a result, the length of hospital stays decreased a median 2.78 days for patients who received transfusions after an anemia management clinic visit compared with patients not seen in the clinic.

Perepu and colleagues acknowledged that the heterogeneity of their surgical population and short timespan since implementation of the clinic limited their analysis. However, the implementation of a structured preoperative anemia management clinic with automatic referral workflow appears feasible and results in reductions in blood transfusions and the length of hospital stays, they wrote. – by Chuck Gormley

Reference:

Perepu US, et al. Abstract 1004. Presented at ASH Annual Meeting and Exposition; Dec. 3-6, 2016; San Diego.

Disclosure: Researchers report no relevant financial disclosures.