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Overview and Implications

Hemorrhage or hemorrhagic anemia refers to anemia secondary to acute blood loss associated with a medical or surgical procedure. Bleeding is a potential complication of any surgical procedure, and the risk is proportional to the size and complexity of the surgery. High blood loss is associated with certain types of surgery such as cardiac and liver surgeries, certain orthopaedic procedures (such as hip replacement) and obstetric surgery. Mortality may be greatly increased when severe bleeding occurs during the operative procedure (National Institute for Health and Care Excellence (NICE), 2014).

A search of patient safety reporting/alert systems uncovered the following incidents of hemorrhage for patients undergoing medical or surgical procedures:

  • Hemorrhage after liver biopsy (National Patient Safety Agency (NPSA) & National Reporting and Learning Service (NRLS), 2009)
  • Hemorrhage following removal of femoral catheter (NPSA & NRLS, 2010b)
  • Hemorrhage from arteriovenous fistula (NPSA & NRLS, 2011)
  • Hemorrhage following placement of gastrostomy (NPSA & NRLS, 2010a)
  • Hemorrhage during dialysis (Veterans Affairs Central Office, National Center for Patient Safety, 2008)
  • Hemorrhage during/following colonoscopy (Oregon Patient Safety Commission, 2015)

There is a relationship between pre-operative anemia and hemorrhage during surgical procedures. Iron deficiency is a common cause of pre-operative anemia and it should be corrected at prior to surgery to achieve optimal results (Gombotz, 2012; Theusinger et al., 2014; Theusinger et al., 2007). Bleeding that occurs in hospital as a result of a medical or surgical procedure is associated with increased morbidity, mortality and increased length of stay (Clevenger et al., 2015; Ferraris et al., 2012; Gombotz, 2012; Muñoz et al., 2016; Musallam et al., 2011; Spahn, 2010).

For additional information regarding Hospital Harm anemia – hemorrhage, please refer to the Hospital Harm Improvement Resource Anemia – Hemorrhage: Health Care / Medication Associated Condition.

Goal

Reduce the incidence of hemorrhage or hemorrhagic anemia secondary to medical or surgical procedures.

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