Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2026
Improving Anemia and Curbing Transfusion in Gynaecologic Surgery (IMPACT-GS): Multidisciplinary and Multimodal Preoperative Hemoglobin Optimization.
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Chen Innie, Khamisa Karima, Clancy Aisling, Singh Sukhbir, Tinmouth Alan, Touchie Donna, Fergusson Dean, Gagne Sylvain, Pysyk Christopher, Graham Megan, Duke Kate, Prince Amy, Choudhry Abdul Jamil, Gomes Megan
Аннотация
OBJECTIVES: To assess the effect of a multidisciplinary and multimodal intervention bundle on preoperative hematologic parameters and perioperative transfusion rates.
METHODS: A multidisciplinary and multimodal hemoglobin optimization intervention bundle was developed and implemented at a tertiary academic centre (April-June 2023) to include clinical care algorithms based on preoperative hemoglobin values, dedicated nursing interventions, electronic medical record reminders, patient educational material, and department-wide communication strategies with clinical teams. A retrospective analysis was conducted to assess the effect of this intervention bundle.
RESULTS: A total of 2026 hysterectomies were included (908 pre-intervention and 1118 after intervention). Following intervention, there was an increase in mean preoperative hemoglobin level (129.7 ± 15.4 g/L before intervention to 131.7 ± 14.1 g/L after intervention, P < 0.05). Overall, there was no significant difference in the proportions of preoperative anemia (Hb <120 g/L) between periods. There was a reduction in patients with preoperative hemoglobin values lower than 110 g/L (9.5% before intervention to 6.6% after intervention, P < 0.05) and 100 g/L (5.5% before intervention to 2.7% after intervention, P < 0.05). Following intervention, there was a decrease in perioperative transfusion rates (4.3% before intervention to 2.5% after intervention, P < 0.05), as well as postoperative transfusion rates (3.5% before intervention to 2.0% after intervention, P < 0.05). Compared with pre-intervention, there were decreased odds of preoperative Hb <110 g/L (OR 0.678; 95% CI 0.476-0.966), Hb <100 g/L (OR 0.486; 95% CI 0.295-0.802), receiving a perioperative (OR 0.572; 95% CI 0.349-0.938) and postoperative transfusion (OR 0.549; 95% CI 0.317-0.952).
CONCLUSIONS: A multidisciplinary, multimodal approach to preoperative hemoglobin optimization can significantly reduce transfusion rates, thereby improving gynaecologic surgery outcomes.
METHODS: A multidisciplinary and multimodal hemoglobin optimization intervention bundle was developed and implemented at a tertiary academic centre (April-June 2023) to include clinical care algorithms based on preoperative hemoglobin values, dedicated nursing interventions, electronic medical record reminders, patient educational material, and department-wide communication strategies with clinical teams. A retrospective analysis was conducted to assess the effect of this intervention bundle.
RESULTS: A total of 2026 hysterectomies were included (908 pre-intervention and 1118 after intervention). Following intervention, there was an increase in mean preoperative hemoglobin level (129.7 ± 15.4 g/L before intervention to 131.7 ± 14.1 g/L after intervention, P < 0.05). Overall, there was no significant difference in the proportions of preoperative anemia (Hb <120 g/L) between periods. There was a reduction in patients with preoperative hemoglobin values lower than 110 g/L (9.5% before intervention to 6.6% after intervention, P < 0.05) and 100 g/L (5.5% before intervention to 2.7% after intervention, P < 0.05). Following intervention, there was a decrease in perioperative transfusion rates (4.3% before intervention to 2.5% after intervention, P < 0.05), as well as postoperative transfusion rates (3.5% before intervention to 2.0% after intervention, P < 0.05). Compared with pre-intervention, there were decreased odds of preoperative Hb <110 g/L (OR 0.678; 95% CI 0.476-0.966), Hb <100 g/L (OR 0.486; 95% CI 0.295-0.802), receiving a perioperative (OR 0.572; 95% CI 0.349-0.938) and postoperative transfusion (OR 0.549; 95% CI 0.317-0.952).
CONCLUSIONS: A multidisciplinary, multimodal approach to preoperative hemoglobin optimization can significantly reduce transfusion rates, thereby improving gynaecologic surgery outcomes.