Hemoglobin Optimization to Improve Cerebral Health in Anemic Patients Undergoing Non-Cardiac Surgery
Quality and Safety
SMH-15-012 We propose a transformation in local and global healthcare by assess the optimal effective and safe treatment of anemia in patients undergoing elective surgery utilizing well established and readily adoptable protocols including the administration of iron and erythroid stimulating agents (ESAs). The goal of our program is to improve patient outcomes including; reduced red blood cell (RBC) transfusion, maintain or improve cognitive function, optimize cerebral oxygen delivery as assessed by MRI imaging and reduced series adverse events such as stroke and myocardial infarction. Following a full assessment of anemia treatment protocols, these approaches will be readily translatable to a broad patient population.
SMH-15-012 Anemia is a global health problem affecting about 1/3 of the world’s population. Its impact spans all ages and is a leading cause of years lived with. Many patients are anemic prior to undergoing elective surgery (~30%), despite its association with increased morbidity and mortality. Available therapies are currently underutilized for its treatment. We are assessing the optimal method to treat anemia and to determine if such treatment can improve cognitive abilities and prevent cognitive decline in patients undergoing major joint replacement. Anemia patients undergoing elective surgery experience a very high RBC transfusion rate (~25%). Recent clinical trials have identified that RBC transfusion does not prevent complications associated with anemia, and therefore is not the solution. Implementation of blood conserving therapies, including TXA, has dramatically reduced RBC transfusion rates, but anemic patients remain at higher risk for RBC transfusion and adverse events. Our systematic review lead to the designed and implemented a clinical trial to determine the most effective and safest manner to treat anemic patients prior to surgery. The trial will compare two methods of therapy, iron alone or iron plus ESA, to determine which method is superior to treat anemia. We will utilize this trial to assess the cognitive abilities of these patients to determine if they are impacted by anemia and subsequently improved by anemia treatment prior to and following surgery. Finally, we plan to utilize sophisticated functional MRI methodology to assess the impact of anemia treatment of improving brain physiology and oxygen delivery. The outcomes of this study will identify the most effective and safe therapy to treat anemia and determine if this treatment can improve cerebral, and overall health, of our patients.