title: 'Fit to fly': overcoming barriers to preoperative haemoglobin optimization in surgical patients.
abstract: In major surgery, the implementation of multidisciplinary, multimodal and individualized strategies, collectively termed Patient Blood Management, aims to identify modifiable risks and optimise patients' own physiology with the ultimate goal of improving outcomes. Among the various strategies utilized in Patient Blood Management, timely detection and management of preoperative anaemia is most important, as it is in itself a risk factor for worse clinical outcome, but also one of the strongest predisposing factors for perioperative allogeneic blood transfusion, which in turn increases postoperative morbidity, mortality and costs. However, preoperative anaemia is still frequently ignored, with indiscriminate allogeneic blood transfusion used as a 'quick fix'. Consistent with reported evidence from other medical specialties, this imprudent practice continues to be endorsed by non-evidence based misconceptions, which constitute serious barriers for a wider implementation of preoperative haemoglobin optimisation. We have reviewed a number of these misconceptions, which we unanimously consider should be promptly abandoned by health care providers and replaced by evidence-based strategies such as detection, diagnosis and proper treatment of preoperative anaemia. We believe that this approach to preoperative anaemia management may be a viable, cost-effective strategy that is beneficial both for patients, with improved clinical outcomes, and for health systems, with more efficient use of finite health care resources.
authors.affiliation: Perioperative Transfusion Medicine, School of Medicine mmunoz@uma.es.
authors.forename: M
authors.initials: M
authors.lastname: Muñoz
authors.affiliation: Internal Medicine, Xanit International Hospital, Benalmádena, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Gómez-Ramírez
authors.affiliation: Anaesthesiology and Intensive Care, Evangelical Hospital, Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Kozek-Langeneker
authors.affiliation: Anaesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA.
authors.forename: A
authors.initials: A
authors.lastname: Shander
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Richards
authors.affiliation: Department of Pharmacology, School of Medicine, University of Málaga, Málaga, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Pavía
authors.affiliation: Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University and The Lundbeck Foundation Center for fast-track hip and knee arthroplasty, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
authors.affiliation: Division of Gastrointestinal Surgery, Nottingham Digestive Disease Centre NIHR, Biomedical Research Unit, Queen's Medical Centre, Nottingham, UK.
authors.forename: A G
authors.initials: AG
authors.lastname: Acheson
authors.affiliation: Department of Anaesthesiology, Cardiff & Vale University Health Board, Cardiff, UK.
authors.forename: C
authors.initials: C
authors.lastname: Evans
authors.affiliation: Department of Anaesthesiology, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Raobaikady
authors.affiliation: Anaesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA.
authors.forename: M
authors.initials: M
authors.lastname: Javidroozi
authors.affiliation: Department of Haematology-Oncology, School of Medicine Georgetown University, Washington, DC, USA.
authors.forename: M
authors.initials: M
authors.lastname: Auerbach
mesh_terms: D000740:Anemia / Q000175:diagnosis* / Q000628:therapy*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D011300:Preoperative Care; D012307:Risk Factors; D013514:Surgical Procedures, Operative
chemical_list: D006454:Hemoglobins
keywords: blood, erythrocytes; blood, transfusion; surgery, preoperative period