Figure 2 – The Hillingdon and Mount Vernon Hospitals Rapid Recovery Programme Anaesthesia and Analgesia Guidelines
Interestingly, the study does raise questions with regards to the management of anaemic patients. Anaemic patients who did not have their anaemia corrected had a statistically significant reduced LOS than anaemic patients who were managed according to the protocol (median LOS 6 days vs 7 days, P = 0.005). Negative binomial regression analysis also signifies that managing anaemia according to the protocol does have a predictably longer LOS as demonstrated in Table 4 (P < 0.001), thus supporting the evidence seen. This would suggest that the current management protocol is not effective. NATA guidelines had suggested that as well as iron therapy, erythropoietin injections could also be considered as part of the management protocol[8, 13] to manage both iron deficiency anaemia and anaemia of chronic disease. It is also worth noting that oral iron therapy is not always well tolerated by patients (with the side effects of gastrointestinal disturbances) and hence, patient compliance may play a factor in the results seen. Nevertheless, with the small sample size of 25 anaemic patients receiving pre-operative treatment, and without examining the anaesthetic technique used (general vs regional anaesthesia) it is difficult to speculate on the cause for this difference seen. However, the statistics do show a significant difference and it is one that could benefit from further studies to understand this better. It is also worth taking into consideration complications unrelated to anaemia and the surgery which could have contributed to some patients requiring a longer length of stay, for example, post-operative hospital acquired pneumonia or myocardial infarction. These are not reflected separately in the results, and although they may be comparably low in numbers, they may skew the data in a small cohort.