RecruitingACTRN12621001517864

POST-operative Variations in anaemia treatmenT and Transfusions (POSTVenTT)

POST-operative Variations in anaemia treatmenT and Transfusions (POSTVenTT): a prospective, multicentre, observational cohort study of anaemia after major abdominal surgery

Sponsor

South Metropolitan Health Service (SMHS)

Enrollment

2,000 participants

Start Date

Jul 1, 2021

Study Type

Observational

Conditions

Perioperative anaemia following major abdominal surgery

Summary

Anaemia affects nearly a quarter of the world and is common in surgical patients. A third of patients present with preoperative anaemia and three quarters of patients are discharged from hospital with anaemia. The World Health Organisation defines anaemia as an insufficient circulating red cell mass, with a haemoglobin (Hb) concentration of < 130 g/L for men and < 120 g/L for women. Perioperative anaemia is associated with delayed patient recovery and increased postoperative complications, leading to increased post-operative morbidity and mortality. In recent years, there has been a significant increase in the in the use of intravenous iron therapy for preoperative anaemia in line with major international guidelines. This is common practice in Australia and New Zealand. However, the recent PREVENTT study has questioned the value of preoperative iron transfusion in anaemic patients. Management of anaemia in the perioperative setting is variable and compliance to recommended practices such as measurement of haemoglobin levels, use of tranexamic acid, and avoidance of oral iron remains unknown. The POSTVenTT (POST-operative Variations in anaemia treatmenT and Transfusions) audit aims to determine the variability in adherence to anaemia management guidelines in the perioperative setting and to assess its impact on clinical outcomes following major abdominal surgery.

Eligibility

Sex: Both males and femalesMin Age: 18 Yearss

Inclusion Criteria4

Consecutive adult patients undergoing major emergency or elective abdominal surgery will be eligible for inclusion.
Age: Adult patients, 18 years or above
Procedure: Major abdominal surgery, defined as an operation with an incision into the abdominal cavity and anticipated duration of more than one hour. Procedures performed using any surgical approach, including open, laparoscopic, and robotic surgery are included.
Urgency: Patients undergoing planned (elective or expedited) or unplanned (emergency) surgery.

Exclusion Criteria6

Procedures: Abdominal surgery classified as minor operations such as; laparoscopic appendicectomy (emergency or elective), endoscopic procedures, transanal or transurethral procedures. A complete list can be found in the appendix 1.
Indication: Palliative procedures as determined pre-operatively and explicitly stated in the medical record or consent form.
Extent of surgery: Operations that are either:
Staged with a planned return for reoperation (such as but not limited to damage control laparotomy or burns surgery)
Change in operative plan such that during the first procedure it is determined that a reoperation is necessary, even if the patient was enrolled pre-operatively
Return to theatre: Patients returning to theatre due to complications following earlier surgery can be included, as long as their index procedure has not already been included in the study.

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Interventions

An audit of the compliance to pre-, intra-, and postoperative guidelines for the management of anaemia in patients undergoing major abdominal surgery. The audit aims to follow up with patients at arou