Search

This article is a guideline from the British Society for Haematology on the identification and management of preoperative anaemia in adults. It provides recommendations on diagnosing anaemia, managing iron deficiency, and the appropriate use of erythropoiesis-stimulating agents and preoperative transfusion. The guideline emphasizes the importance of early assessment for anaemia in patients undergoing elective surgery and the need for shared decision-making regarding further management. It also discusses the association of preoperative anaemia with adverse outcomes and the role of primary care in managing these patients. The article includes information on the definition of anaemia, diagnosing iron deficiency, investigating individuals with iron deficiency, and algorithms for anaemia investigation. The guidelines recommend oral iron therapy as the first-line treatment for iron deficiency anemia (IDA), as it is safe, effective, and cost-efficient. Intravenous (IV) iron therapy may be considered for patients who are intolerant to oral iron or who do not respond well to it. However, the guidelines do not recommend IV iron therapy for all patients with anemia. The timing of iron therapy in relation to surgery is not well-defined, and further research is needed in this area. The guidelines also discuss the treatment of vitamin B12 or folate deficiency and the use of erythropoiesis-stimulating agents. Preoperative transfusion should only be considered in very anemic patients when there is an urgency for surgery and other options for managing anemia are not feasible. Further research is needed [Extracted from the article]

There has been rapid growth in the purchase of surgical robots in both North America and Europe in recent years. Whilst this technology promises many benefits for patients, the introduction of such a complex interactive system into healthcare practice often results in unintended consequences that are difficult to predict. Decision making by surgeons during an operation is affected by variables including tactile perception, visual perception, motor skill, and instrument complexity, all of which are changed by robotic surgery, yet the impact of robotic surgery on decision making has not been previously studied. Drawing on the approach of realist evaluation, we conducted a multi-site interview study across nine hospitals, interviewing 44 operating room personnel with experience of robotic surgery to gather their perspectives on how robotic surgery impacts surgeon decision making. The findings reveal both potential benefits and challenges of robotic surgery for decision making.