Implementation of a short-term treatment protocol in anemic patients before cardiac surgery.

BACKGROUND: We assessed whether implementation of an immediate preoperative treatment in anemic patients could result in fewer perioperative packed red blood cell (PRBC) transfusions and improved outcomes in a real-world setting.

METHODS: Starting onFrom January 1st, 20202020, to November 31st, 2022, we implemented a perioperative protocol for anemic patients (women Hemoglobin (Hb) <11.5 g/dL, men Hb<12.5 g/dL), which included subcutaneous erythropoietin alpha, intravenous Iron, and intramuscular vitamin B12 (all given preoperatively) and per os Iron and folic acid given once a day postoperatively. 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. Primary outcome was amount of PRBC transfusions during surgery and index admission.

RESULTS: In the months after protocol implementation, 114 patients who received the treatment protocol were compared to 236 anemic patients in the four years prior who did not receive the protocol. The treatment reduced total PRBC use (control group median 4 [2-7] units vs. treatment 2 [1-3] units, p<.0001) and the incidence of post-operative blood products transfusions (treatment group 58 patients, 50.88% vs control group 177 patients, 75%, p<.0001). Hb prior to discharge was higher among the protocol group (treatment median 9 [8.3-9.5] g/dL vs. control 8.6 [8.1-9.1] g/dL, p=0.0081).

CONCLUSIONS: Despite some differences compared to previously described protocols, the implementation of a perioperative treatment protocol for anemic patients was associated with a reduction in PRBC transfusion in a real-world setting.