Introduction/Background*Anaemia (haemoglobin <130g/l) is an established, independent risk factor for perioperative morbidity and mortality1, the aetiology of which is diverse within in the gynaecological oncology population. We audited the management and consequences of perioperative anaemia in accordance with NICE guidelines2 in a quaternary gynaecological oncology unit in London, United Kingdom (UK).
Methodology We performed a retrospective electronic case note review of women undergoing major (M) or major-plus (MP) gynaecological oncology surgeries between 1stSeptember 2019 and 29th February 2020. The category of operation was standardised at the unit.
Result(s)*Of 236 notes audited, 58.5% (n = 138) were anaemic pre-operatively.
87/236 patients underwent M surgery and 149/236 patients underwent MP surgery. The prevalence of anaemia was 43.7% in the M cohort (n=38) versus 67.1% in the MP cohort (n = 100). Mean Hb was the same between groups (113.4g/L vs. 113.4g/L). Only 4% (n=6) of patients had iron studies sent pre-operatively. No patients received an iron infusion pre-operatively, whilst 2.9% of patients had pre-operative blood transfusions.
The mean estimated blood loss (EBL) for all groups was 289.4ml. 53% of patients (n = 125) did not have any documented operative EBL. The overall incidence of post-operative blood transfusion was 24.6% (n=58). Women identified with pre-operative anaemia had a higher incidence of post-operative blood transfusion (anaemic 35.5% vs. non anaemic 9.2%).
Mean length of stay (LOS) was greater in anaemic M (3.4 vs.2.2 days) and MP (6.9 days vs. 5.1 days) procedures compared to their non-anaemic counterparts.
Conclusion*Our analysis reveals a need for improvement in the management of peri-operative anaemia in our population. It also demonstrates the peri-operative consequences of untreated anaemia including a higher incidence of post-operative blood transfusion and increased LOS.
Our department is working to define a specific anaemia management pathway for all patients undergoing M or MP gynaecological surgery and we aim to undertake a randomised control trial to show our results.
• Musallam KM et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study Lancet. 2011 Oct 15;378(9800):1396-407. doi: 10.1016/S0140-6736(11)61381-0. Epub 2011 Oct 5.
National Institute for Health and Care Excellence. Perioperative care in adults; NICE guideline 2020 (Clinical guideline [NG180]). Available from https://www.nice.org.uk/guidance/ng180
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