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.