1.
Anemia Management and Audit Feedback Practices for Reducing Overuse of RBC Transfusion: A Laboratory Medicine Best Practice Systematic Review and Meta-Analysis
Derzon J, Alford A, Clarke N, Gross I, Shander A, Thurer R
American Journal of Clinical Pathology. 2018;151((1):):18-28
Abstract
Objectives: To evaluate the effectiveness of anemia management and audit with feedback practices in reducing overuse of RBC transfusion. Methods: This review follows the Centers for Disease Control and Prevention's Laboratory Medicine Best Practice Systematic Review (A-6) method. We searched the literature and solicited unpublished studies on practices to reduce overuse of RBC transfusions as measured by reductions in units transfused and proportion of patients transfused. Results: Thirteen studies on preoperative anemia management and three studies on audit feedback practices met inclusion criteria. Strength of evidence was high to moderate for reducing the number of units and proportion of patients transfused. Conclusions: Preoperative anemia management reduces the proportion of patients transfused and units of RBCs transfused. Audit with feedback across cases, physicians, and/or service areas, as part of a continuous quality improvement practice, reduces the proportion of patients and units of RBCs transfused.
2.
Prevalence and outcomes of anemia in surgery: a systematic review of the literature
Shander A, Knight K, Thurer R, Adamson J, Spence R
American Journal of Medicine. 2004;116((7, Suppl 1):):58s-69s.
Abstract
Untreated preoperative anemia and acute perioperative blood loss may add to surgical risk. To understand the prevalence of anemia in surgical patients (with a primary focus on preoperative anemia), and the impact that preexisting anemia has on transfusion rates as well as on clinical and functional outcomes, a systematic review was performed of articles published between January 1966 and February 2003. The estimates of anemia prevalence in the literature ranged widely, from 5% in geriatric women with hip fracture to 75.8% in patients with Dukes stage D colon cancer. Diagnosis of anemia was most strongly associated with an increased risk of receiving an allogeneic transfusion. In general, patients who donated autologous blood preoperatively received less allogeneic blood than those who did not donate. There was some suggestion that lower hemoglobin levels are associated with decreased survival rates, although this was not found universally. Too few studies were found that evaluated the impact of anemia on other outcomes, such as functional status and costs and resource utilization, to draw reliable conclusions. Several other factors also limited the interpretation of the data, including the lack of a uniform definition for anemia and a dearth of studies expressly designed to quantify the prevalence and impact of anemia. Establishing a uniform definition and specifically evaluating the effect of anemia on outcomes are important considerations for future study.