- Describe your topic.
- Overarching Question - In the context of Patient Blood Management: how can we approach the efficient diagnosis of treatable anemia in the preoperative time frame? Given the expansive scope of anemia overall, we have tried to narrow it down for a starting point of iron-deficiency in the pre-op patients. Additional background information will be provided. Key questions: Does a multidisciplinary anemia management program using a laboratory-based algorithm to identify and treat potentially iron-responsive anemias result in improved outcomes in pre-operative elective surgery patients? Are outcomes using parenteral iron superior to oral iron? (This may or may not be out of scope) • Population: All patients undergoing elective surgery • Intervention: Identify and treat pre-operative patients with potentially iron-responsive conditions. • Comparison: o Compare elective surgery outcomes of patients treated with and without preoperative iron deficiency management. o Compare outcomes in programs using parenteral iron to those using only oral iron. • Possible Outcomes: 1. Postoperative anemia incidence 2. Postoperative infection rate 3. Ischemic event occurrences 4. Mortality 5. Allogeneic transfusion 6. Cost of care 7. Length of stay 8. Scheduling delays Keywords: Elective surgery, anemia, iron deficiency, anemia of chronic disease, iron replacement, Patient Blood Management. References: International consensus statement on the peri‐operative management of anaemia and iron deficiency. 20 December 2016 https://doi.org/10.1111/anae.13773 Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study Lancet Volume 378, Issue 9800, 15–21 October 2011, Pages 1396-1407 Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines BJA January 2011Volume 106, Issue 1, Pages 13–22 A multicentre comparative study on the efficacy of intravenous ferric carboxymaltose and iron sucrose for correcting preoperative anaemia in patients undergoing major elective surgery BJA: British Journal of Anaesthesia, Volume 107, Issue 3, 1 September 2011, Pages 477–478
- Describe why this topic is important.
- Background: Anemia is a strong risk factor for poor surgical outcomes. Preoperative anemia is associated with increased transfusions which add significant costs and are independently predictive of poorer outcomes. The prevalence of anemia in the preoperative population varies from 5-75% depending on patient age and underlying medical problems. Iron deficiency anemia (IDA) and anemia of chronic disease with iron deficiency (ACD/IDA) make up the bulk of rapidly treatable conditions seen in pre-op patients (“iron responsive”).
- Tell us why you are suggesting this topic.
- Many publications advocate adoption of preoperative anemia programs, but recommendations vary on whether and how best to do this. A systematic review of the literature would be helpful in determining whether and how to implement a preoperative anemia program. We have been working internally to narrow the scope and focused on the most common, treatable conditions causing anemia in preoperative patients.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- The College of American Pathologists (CAP) Pathology and Laboratory Quality Center, along with our professional partners, is advancing the practice of pathology and laboratory medicine by bringing evidence-based guidelines, and consensus recommendations to the forefront of clinical decision making. Adopting these guidelines helps pathologists and laboratory professionals to provide more effective testing with consistent, high-quality results, and expert interpretations.
- How will you or your group use the information from a new evidence report?
- The CAP will form an expert panel to draft recommendations based on the NAM Standards for Developing Trustworthy Guidelines. We have recently adopted the GRADE framework for our final recommendation language. http://www.cap.org/web/home/protocols-and-guidelines/cap-guidelines/cap-guideline-principles?_afrLoop=21766274810336#!%40%40%3F_afrLoop%3D21766274810336%26_adf.ctrl-state%3Dnbej0d3c5_38
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- The CAP develops a Stakeholder Analysis and Risk Report and Project Protocol where we identify our target audience as applicable (e.g., pathologists, oncologists, family physicians, surgeons, internists, etc)
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- The College of American Pathologists
- Information About You: (optional)
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- Provide a description of your role or perspective.
- The College of American Pathologists (CAP), the leading organization of board-certified pathologists, serves patients, pathologi
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- CAP
- Please tell us how you heard about the Effective Health Care Program.
- Call for topics email/notice
