Identifying and Addressing Preoperative Iron Deficient Anemia in the Orthopedic Surgery Setting: A Needs Assessment Project

Background:Despite national standards regarding the recommendations for treating anemia preoperatively in the elective surgery population, in many institutions these guidelines are not followed. The purpose of this assessment was to determine the needs and improvement opportunities of preoperative anemia management among patients at a large academic medical center in urban Utah. The ultimate goal beyond this project would be to implement an intervention that would decrease the incidence of red cell transfusion in the orthopedic surgery postoperative population with implementation of iron transfusion therapy in those with identified iron deficiency anemia.Methods:Two hundred and one charts were audited using a checklist, and data was extracted including demographics, labs and perioperative interventions. An evidence-based referral algorithm was then developed and presented to key stakeholders at the system level for the sites organization, and their feedback was elicited. These guidelines will be used by orthopedic providers at this institution in the future to properly refer patients in the event of anemia.Results:Results revealed that 29.9% of patients presented with anemia in the months prior to their surgery. 79% of patients who received a blood transfusion postoperatively, were shown to be anemic preoperatively. No patients were referred for preoperative intervention regarding preoperative anemia. Significantly, 47.5% of patients undergoing a total hip revision received a blood 2 transfusion, and 20.6% of knee revisions received a blood transfusion. Less than 3% of primary joint surgeries received transfusions. Conclusions:Revision surgery patients with anemia and/or comorbidities are more likely to need an RBC transfusion postoperatively. Results demonstrate that within this population there is a lack of compliance by providers with national guidelines of preoperative anemia management. Improvement potential exists in outcomes among this population including shorter hospital stays, cost savings, less incidence of RBC transfusion postoperatively, and overall lower morbidity/mortality.