The management of peri‐operative anaemia in patients undergoing major abdominal surgery in Australia and New Zealand: a prospective cohort study

OBJECTIVES: To assess the prevalence and management of anaemia in patients undergoing major abdominal surgery, and the influence of guideline adherence on patient outcomes. DESIGN: Prospective observational cohort study. SETTING: 56 hospitals in Australia and New Zealand. PARTICIPANTS: People aged 18 years or more who underwent major abdominal surgery during two 2‐week periods in July 2021. MAIN OUTCOME MEASURES: Proportions of patients managed according to Australian National Blood Authority patient blood management guidelines. Secondary outcomes: anaemia prevalence, post‐operative complications, length of hospital stay, re‐admission within 30 days of discharge. RESULTS: Data were available for 2730 eligible patients (mean age, 56.7 years; SD, 17.3 years), including 1558 women (57.1%). Haemoglobin levels prior to surgery were documented for 2461 of 2727 patients (90.2%), 689 of whom had anaemia (28.0%). Pre‐operative anaemia assessment and management were associated with lower likelihood of intra‐operative (adjusted odds ratio [aOR], 0.33; 95% CI, 0.19–0.57) and post‐operative blood transfusion (aOR, 0.36; 95% CI, 0.25–0.53), and of post‐operative complications (aOR, 0.79; 95% CI, 0.63–0.99). Tranexamic acid was administered during 128 of 2728 procedures (4.7%); a restrictive transfusion strategy was followed for 96 of the 167 patients who received post‐operative blood transfusions (58%). Post‐operative anaemia was identified in 1227 of 2069 patients (59.3%) in whom haemoglobin was assessed prior to discharge. The proportion of people re‐admitted to hospital within 30 days was larger for patients with anaemia at discharge (169 of 1207 patients followed up, 14.0% v 61 of 825, 7.4%). Haemoglobin assessments were recorded by 30 days after discharge for only 288 patients with post‐operative anaemia (24.3%). CONCLUSIONS: The management of peri‐operative anaemia differs between hospitals in Australia and New Zealand, with consequences for patient outcomes. Patients are often discharged after surgery with anaemia, which is therefore a potential therapeutic target. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12621001517864 (retrospective).