Surgical Patient Optimization: Anemia, Glycemic Control and Enhanced Recovery After Surgery

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If you are unable to join with the below options, there will be a physical space reserved in the Foundation for Health Care Quality’s Seattle office to participate in the virtual meeting at the below address:

Industrious 400U @ Rainier Square
400 University Street
Floor 3
Seattle, WA 98101

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Background

Modifiable attributes of patient health status such as anemia or blood sugar control can have negative consequences for recovery after surgery. Preoperatively anemic individuals have higher costs generally due to increased length of stay[i] and even mild preoperative anemia is associated with an increase in 30-day morbidity[ii] lower quality of recovery and higher adjusted risk of death and disability.[iii] Some studies suggest poor A1c control preoperatively increases morbidity and mortality,[iv] but perioperative glucose is a stronger predictor of 30-day mortality.[v] Enhanced Recovery After Surgery (ERAS) protocols improve length of stay and reduce total cost of care, complications, and readmissions.[vi] However, Washington State has variation for A1c optimization before surgery, perioperative glycemic control protocols, and perioperative anemia control. Black patients are three to four times more likely to experience anemia perioperatively; Black, Hispanic, American Indian/Alaska Native patients more likely to experience uncontrolled diabetes/serum glucose, leading to inequitable outcomes.

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[i] Schatz C, Plötz W, Beckmann J, Bredow K, Leidl R, Buschner P. Associations of preoperative anemia and postoperative hemoglobin values with hospital costs in total knee arthroplasty (TKA). Arch Orthop Trauma Surg. 2023 Nov;143(11):6741-6751.

[ii] Musallam KM, et al. . Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011 Oct 15;378(9800):1396-407.

[iii] Myles, P. S., Richards, T., Klein, A., Wood, E. M., Wallace, S., Shulman, M. A., Martin, C., Bellomo, R., Corcoran, T. B., Peyton, P. J., Story, D. A., Leslie, K., Forbes, A., & RELIEF Trial Investigators (2022). Postoperative anaemia and patient-centred outcomes after major abdominal surgery: a retrospective cohort study. British journal of anaesthesia, 129(3), 346–354. https://doi.org/10.1016/j.bja.2022.06.014

[iv] Hart, A., Goffredo, P., Carroll, R., Lehmann, R., Nau, P., Smith, J., Ahad, S., Bao, W., & Hassan, I. (2021). Optimizing Bariatric Surgery outcomes: the impact of preoperative elevated hemoglobin A1c levels on composite perioperative outcome measures. Surgical endoscopy, 35(8), 4618–4623.

[v] van den Boom, W., Schroeder, R. A., Manning, M. W., Setji, T. L., Fiestan, G. O., & Dunson, D. B. (2018). Effect of A1C and Glucose on Postoperative Mortality in Noncardiac and Cardiac Surgeries. Diabetes care, 41(4), 782–788.

[vi] Mazni Y, Syaiful RA, Ibrahim F, Jeo WS, Putranto AS, Sihardo L, Marbun V, Lalisang AN, Putranto R, Natadisastra RM, Sumariyono S, Nugroho AM, Manikam NRM, Karimah N, Hastuty V, Sutisna EN, Widiati E, Mutiara R, Wardhani RK, Liastuti LD, Lalisang TJM. The enhanced recovery after surgery (ERAS) protocol implementation in a national tertiary-level hospital: a prospective cohort study. Ann Med Surg (Lond). 2023 Dec 8;86(1):85-91.