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

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 appr
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.
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Author:Lawrence Tim Goodnough, Alice Maniatis, Peter Earnshaw, Goran Benoni, Photis Beris, Elvira Bisbe, Dean A. Fergusson, Hans Gombotz, Oliver Habler, Terri G. Monk, Yves Ozier, Robert Slappendel, Marek Szpalski
URN:urn:nbn:de:hebis:30:3-265832
DOI:http://dx.doi.org/10.1093/bja/aeq361
ISSN:1471-6771
ISSN:0007-0912
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=21148637
Parent Title (English):British journal of anaesthesia
Publisher:Oxford Univ. Press
Place of publication:Oxford [u.a.]
Document Type:Article
Language:English
Year of Completion:2011
Year of first Publication:2011
Publishing Institution:Univ.-Bibliothek Frankfurt am Main
Release Date:2012/10/12
Tag:anaemia; blood transfusion; orthopaedic surgery; preoperative assessment; preoperative preparation
Volume:106
Pagenumber:10
First Page:13
Last Page:22
Note:
© The Author [2011]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Journal: Dazugehörige Zeitschrift anzeigen
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell 3.0

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