title: PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery: a multicentre, observational study.
abstract: BACKGROUND
  Patient blood management (PBM) can prevent preoperative anaemia, but little is known about practice in Europe.
  
  
  OBJECTIVE
  To assess the pre and postoperative prevalence and perioperative management of anaemia in patients undergoing elective orthopaedic surgery in Europe.
  
  
  METHODS
  An observational study; data were collected from patient records via electronic case report forms.
  
  
  METHODS
  Seventeen centres in six European countries. Centres were stratified according to whether they had a PBM programme or not.
  
  
  METHODS
  One thousand five hundred and thirty-four patients undergoing major elective hip, knee or spine surgery [49.9% hip, 37.2% knee, 13.0% spine; age 64.0 years (range 18 to 80), 61.3% female].
  
  
  METHODS
  Prevalence of preoperative (primary endpoint) and postoperative anaemia [haemoglobin (Hb) <13 g dl (male), Hb <12 g dl (female)], perioperative anaemia management, time to first blood transfusion and number of transfused units. Data are shown as mean (SD) or median (interquartile range).
  
  
  RESULTS
  Anaemia prevalence increased from 14.1% preoperatively to 85.8% postoperatively. Mean Hb decrease was 1.9 (1.5) and 3.0 (1.3) g dl in preoperatively anaemic and nonanaemic patients, respectively (P < 0.001). In PBM (n = 7) vs. non-PBM centres, preoperative anaemia was less frequent (8.0 vs. 18.5%; P < 0.001) and iron status was assessed more frequently (ferritin 11.0 vs. 2.6%, transferrin saturation 11.0 vs. 0.1%; P < 0.001). Perioperative anaemia correction (mainly transfusion) was given to 34.3%. Intraoperatively, 14.8% of preoperatively anaemic and 2.8% of nonanaemic patients received transfusions [units per patient: 2.4 (1.5) and 2.2 (1.4), median time to first intraoperative transfusion: 130 (88, 158) vs. 179 (135, 256) min; P < 0.001]. Postoperative complications were more frequent in preoperatively anaemic vs. nonanaemic patients (36.9 vs. 22.2%; P = 0.009).
  
  
  CONCLUSIONS
  Most patients who underwent elective orthopaedic surgery had normal preoperative Hb levels but became anaemic after the procedure. Those who were anaemic prior to surgery had an increased intraoperative transfusion risk and postoperative complication rate. PBM measures such as iron status assessment and strategies to avoid transfusion are still underused in Europe.
authors.affiliation: From the LUNAM Université, Université d'Angers, Department of Anaesthesiology and Reanimation, University Hospital Angers, Angers, France (SL), Department of Orthopaedics, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf (RK), Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany (CVH), Vifor Pharma Ltd., Glattbrugg (AM, SC), and Institute of Anaesthesiology, University and University Hospital of Zurich, Zurich, Switzerland (DRS).
authors.forename: Sigismond
authors.initials: S
authors.lastname: Lasocki
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Krauspe
authors.forename: Christian
authors.initials: C
authors.lastname: von Heymann
authors.forename: Anna
authors.initials: A
authors.lastname: Mezzacasa
authors.forename: Suki
authors.initials: S
authors.lastname: Chainey
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D017558:Elective Surgical Procedures; D057286:Electronic Health Records; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005060:Europe / Q000453:epidemiology; D005260:Female; D005293:Ferritins / Q000097:blood; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011300:Preoperative Care; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D014168:Transferrin / Q000378:metabolism; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D014168:Transferrin; D005293:Ferritins