Are we appropriately screening and treating preoperative anaemia in major elective bowel surgery?

Edgar Poon, Alana Delaforce, David M Pache, Lemya Abdalla, Treasure M McGuire

Research output: Contribution to conferenceAbstractResearchpeer-review

Abstract

Introduction. Preoperative anaemia is associated with poor surgical outcomes, including increased transfusion rate.
Patient Blood Management (PBM) is an approach developed to improve the redress of this issue. In addition, there
is increasing use of iron infusion in the surgical setting, with associated adverse drug events including permanent
skin discolouration and life-threatening hypophosphataemia.

Aims. To assess the appropriateness of anaemia screening and use of iron, and their impact on major bowel surgery
associated with bleeding risk.

Methods. A pharmacist-led multi-disciplinary team retrospectively reviewed 559 patients admitted for elective
major bowel surgery (DRG: G01/02 A/B/C) in a metropolitan tertiary hospital, January 2016 to December 2018.
An electronic audit tool was designed to collect: patient demographics, any anaemia screening within six weeks of
surgery, perioperative use of iron (oral or intravenous) and postoperative outcomes.
Results. Four hundred and sixty-two (82.7%) of 559 patients were preoperatively assessed for anaemia. Of these, 167 (36.2%) were classified as anaemic; and only 34 (20.4%) of this group received preoperative iron. However, quality of preoperative anaemia assessment was poor, with only 51 (11.0%) of tested patients having PBM recommended iron studies, including ferritin, performed. Most anaemia assessments (40.6%) were conducted
within a day of surgery. This is insufficient for anaemia to be corrected. Four iron infusions were prescribed for patients without anaemia. The perioperative transfusion rate was significantly higher in the anaemic group compared
to the non-anaemic group (OR: 3.19, P<0.05).

Discussion. This audit demonstrated that preoperative anaemia is poorly assessed and managed in major bowel
surgery, potentially increasing surgical risk and health expenditure. Feedback to surgeons on the clinical impact of
audit findings has improved their awareness of PBM guidelines. Pharmacists play a key role in improving surgical
quality use of medicines.
Original languageEnglish
Pages41
Number of pages1
Publication statusPublished - 2019
EventAustralasian Pharmaceutical Science Association (APSA) 2019 Annual Conference - Monash University, Melbourne, Australia
Duration: 1 Dec 20194 Dec 2019
http://apsa-online.org/conferences.html

Conference

ConferenceAustralasian Pharmaceutical Science Association (APSA) 2019 Annual Conference
Abbreviated titleAPSA
CountryAustralia
CityMelbourne
Period1/12/194/12/19
Other
The Association hosts an annual conference that provides a forum for presentation of research and development applications from all branches of pharmaceutical science, pharmacy practice and pharmacy education, with an emphasis on participation by postgraduate students.

The Annual Conference is open to members and non-members from related disciplines, and is relevant for:

- academic and industrial scientists associated with drug discovery, drug formulation and drug delivery research and development

- regulatory and clinical scientists involved in bioavailability and bioequivalence study design and assessment, preparation and review of regulatory dossiers

- start-up company representatives faced with implementing strategies for rapid drug discovery and development

- researchers in the clinical and practice areas of pharmacy

- academics with an interest in pharmacy education

- students and postdoctoral fellows from Australia and New Zealand in all areas of pharmaceutical science and pharmacy
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