Results of a short-term treatment protocol in patients with anemia before cardiac surgery

Introduction:

Anemia is a frequent finding in patients scheduled for cardiac surgery and is correlated with adverse events. This study assessed whether implementation of an immediate preoperative treatment protocol in anemic patients could result in reduced perioperative red blood cell (RBC) transfusions and improved outcome.

Patients and methods:

Starting 1.1.2020 we implemented a new perioperative protocol in anemic patients. The protocol included: 40,000 units of S.C erythropoietin alpha; 200mg I.V Venofer; 1000mg I.M vitamin B12 (all given preoperatively as early as possible before surgery) and 80mg P.O Tardyferon and 5mg P.O folic acid given once daily after surgery. All anemic patients (defined as Hgb<10.5 g/dL for women, Hgb<11.5 g/dL for men) were eligible to receive the protocol. Exclusion criteria included same day surgery and patients on chronic erythropoietin treatment. Treating physicians were unaware of treatment initiation. We retrospectively compared all patients receiving the protocol to all eligible patients who were operated on in the four years prior to implementation of the protocol (control group). Main outcome was PRBC transfusion during or after surgery (during the index admission).

Results and discussion:

In the 15 months after protocol implementation, 32 patients received the treatment protocol (average age 66.9, 13 women (40%), average body surface area (BSA) 1.83m², 21 underwent CABG (66%)). In the four years prior (1.1.2016–31.12.2019), 195 patients were eligible to receive the protocol (average age 65.6, 64 women (35%), average BSA 1.85m², 104 underwent CABG (53%)). Preoperative Hgb was similar between groups (treatment 10.2 g/dL vs control 10.1 g/dL, p=0.715). The treatment significantly reduced PRBC use (treatment group median 2.0 PRBC [interquartile range 1-3] versus control 5.0 [3-7], p<0.0001). Hgb prior to discharge was similar between groups (treatment 8.79 g/dL vs. control 8.69 g/dL, p=0.635).

Conclusion:

Implementation of a preoperative treatment protocol for anemic patients significantly decreased PRBC transfusion.