Background/Case Studies: This study addresses challenges in Patient Blood Management (PBM), specifically treating preoperative anemia in cardiac surgery patients within the Calgary Zone. Preoperative anemia is linked with poorer patient outcomes. Locally, cardiac surgery patients have the highest rate of PBM referrals and blood usage. Short lead time to surgery and delays in intravenous (IV) iron treatment due to limited infusion clinic capacity present significant hurdles. IV Iron Sucrose (IS) is covered by the Alberta Health Insurance Plan, however complete therapy requires 3 infusions. IV Iron Derisomaltose (ID) has the benefit of single-dose administration with shorter infusion time butremains inaccessible. It has the potential to enhance treatment completion by eliminating the need for multiple infusion clinic appointments. This study sought to assess characteristics and outcomes of cases where IV iron therapy was completed vs incomplete.
Study
Design/Methods: A retrospective analysis of the Calgary Zone PBM database of cardiac surgery patients from May 2021 to Feb 2023 was conducted. Primary objectives included comparing preoperative hemoglobin (Hgb) and red blood cell transfusion rates between completed and incomplete therapy groups. Secondary objectives assessed treatment completion rates for IS vs ID, surgical delays, and hospital LOS. Normality of continuous variables was assessed using the Shapiro-Wilk test. Group differences were evaluated using the Mann-Whitney U test or Chi-squared test for continuous and categorical outcomes, respectively. Kruskal-Wallis testing was utilized for comparisons involving >2 groups.
Results/Findings: Out of 349 patients referred to the Calgary Zone PBM program, 157 (45%) qualified for IV iron treatment. Among them, 89 (57%) did not receive treatment, 36 (23%) had incomplete treatment, and 32 (20%) completed treatment. Patients who completed treatment had lower Hgb levels at the time of referral by 8 to 10 g/dL on average. However, there was no difference in immediate preoperative Hgb. There were no significant differences in transfusion rates between groups, and no surgeries were delayed for treatment completion. Median hospital LOS was 5 days for patients who completed treatment vs 8 days forpatients who were not treated or received incomplete treatment (Figure 1). Only 5 patients received ID, with 100% completing therapy prior to surgery. Conclusions: Despite lower Hgb at the time of referral, patients who completed treatment caught up and had the same Hgb at the time of surgery and had a lower hospital LOS. This study highlights challenges in PBM related to completion of preoperative anemia treatment in cardiac surgery patients within the Calgary Zone. Findings emphasize the importance of optimizing preoperative anemia treatment protocols to enhance patient outcomes in cardiac surgery.
