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Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines

Goodnough, L. T.; Maniatis, A.; Earnshaw, P.; Benoni, Göran LU ; Beris, P.; Bisbe, E.; Fergusson, D. A.; Gombotz, H.; Habler, O. and Monk, T. G., et al. (2011) In British Journal of Anaesthesia 106(1). p.13-22
Abstract
Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. A standardized approach for the detection, evaluation, and management of anaemia in this setting has been identified as an unmet medical need. A multidisciplinary panel of physicians was convened by the Network for Advancement of Transfusion Alternatives (NATA) with the aim of developing practice guidelines for the detection, evaluation, and management of preoperative anaemia in elective orthopaedic surgery. A systematic literature review and critical evaluation of the evidence was performed, and recommendations were formulated according to... (More)
Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. A standardized approach for the detection, evaluation, and management of anaemia in this setting has been identified as an unmet medical need. A multidisciplinary panel of physicians was convened by the Network for Advancement of Transfusion Alternatives (NATA) with the aim of developing practice guidelines for the detection, evaluation, and management of preoperative anaemia in elective orthopaedic surgery. A systematic literature review and critical evaluation of the evidence was performed, and recommendations were formulated according to the method proposed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. We recommend that elective orthopaedic surgical patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible (Grade 1C). We suggest that the patient's target Hb before elective surgery be within the normal range, according to the World Health Organization criteria (Grade 2C). We recommend further laboratory testing to evaluate anaemia for nutritional deficiencies, chronic renal insufficiency, and/or chronic inflammatory disease (Grade 1C). We recommend that nutritional deficiencies be treated (Grade 1C). We suggest that erythropoiesis-stimulating agents be used for anaemic patients in whom nutritional deficiencies have been ruled out, corrected, or both (Grade 2A). Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value. Implementation of anaemia management in the elective orthopaedic surgery setting will improve patient outcomes. (Less)
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published
subject
keywords
assessment, preoperative, orthopaedic surgery, anaemia, blood transfusion, preoperative preparation
in
British Journal of Anaesthesia
volume
106
issue
1
pages
13 - 22
publisher
Macmillan
external identifiers
  • wos:000285192900004
  • scopus:79551552147
ISSN
1471-6771
DOI
10.1093/bja/aeq361
language
English
LU publication?
yes
id
529a2a05-d7b1-4f39-9063-ab1c5a3184ca (old id 1774010)
date added to LUP
2011-02-01 09:57:52
date last changed
2017-11-19 03:13:55
@article{529a2a05-d7b1-4f39-9063-ab1c5a3184ca,
  abstract     = {Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. A standardized approach for the detection, evaluation, and management of anaemia in this setting has been identified as an unmet medical need. A multidisciplinary panel of physicians was convened by the Network for Advancement of Transfusion Alternatives (NATA) with the aim of developing practice guidelines for the detection, evaluation, and management of preoperative anaemia in elective orthopaedic surgery. A systematic literature review and critical evaluation of the evidence was performed, and recommendations were formulated according to the method proposed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. We recommend that elective orthopaedic surgical patients have a haemoglobin (Hb) level determination 28 days before the scheduled surgical procedure if possible (Grade 1C). We suggest that the patient's target Hb before elective surgery be within the normal range, according to the World Health Organization criteria (Grade 2C). We recommend further laboratory testing to evaluate anaemia for nutritional deficiencies, chronic renal insufficiency, and/or chronic inflammatory disease (Grade 1C). We recommend that nutritional deficiencies be treated (Grade 1C). We suggest that erythropoiesis-stimulating agents be used for anaemic patients in whom nutritional deficiencies have been ruled out, corrected, or both (Grade 2A). Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value. Implementation of anaemia management in the elective orthopaedic surgery setting will improve patient outcomes.},
  author       = {Goodnough, L. T. and Maniatis, A. and Earnshaw, P. and Benoni, Göran and Beris, P. and Bisbe, E. and Fergusson, D. A. and Gombotz, H. and Habler, O. and Monk, T. G. and Ozier, Y. and Slappendel, R. and Szpalski, M.},
  issn         = {1471-6771},
  keyword      = {assessment,preoperative,orthopaedic surgery,anaemia,blood transfusion,preoperative preparation},
  language     = {eng},
  number       = {1},
  pages        = {13--22},
  publisher    = {Macmillan},
  series       = {British Journal of Anaesthesia},
  title        = {Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines},
  url          = {http://dx.doi.org/10.1093/bja/aeq361},
  volume       = {106},
  year         = {2011},
}