Effectiveness of Preoperative Iron Supplementation in Major Surgical Patients With Iron Deficiency

Abstract

Objective: To evaluate the effectiveness of routine intravenous iron in surgical patients with iron deficiency anemia (IDA). Background: Anemia is the most common medical disease in the world and is an independent risk factor for morbidity and mortality. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on surgical outcome. Methods: In this prospective single-center observational study, surgical patients were screened for the presence of anemia and ID. Patients were assigned to 1 of 4 study groups:anemia, iron-deficient, iron supplementation) according to hemoglobin level, iron status, and supplementation with iron. Results: Among 1728 patients, 1028 were assigned to A), a reduced intraoperative transfusion rate was observed for ID and IDA patients only if iron was supplemented >7 days before surgery. Hospital stay was significantly reduced by 2.8 days in ironsupplemented patients (P < 0.01 comparing 13.9 AE 0.8 days for A þ , ID þ , T þ vs. 16.7 AE 0.7 days for A þ ). Conclusion: Preoperative IDA management with intravenous iron is effective in improving hemoglobin level, thereby reducing intraoperative RBC transfusion rate particular if iron is administrated >7 days before surgery. Hospital length of stay was reduced in all preoperatively iron-supplemented IDA patients.

A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women with Heavy Menstrual Bleeding

“…Although less commonly investigated, preoperative ID irrespective of the presence of anemia has been shown to increase the incidence of postoperative mortality, serious adverse events, major cardiac and cerebrovascular events, and use of allogeneic blood transfusions; it also prolongs the length of hospital stay in patients undergoing cardiac surgery [40]. Studies have shown that treatment of ID/IDA prior to surgery can reduce the required number of post-treatment blood transfusions while simultaneously improving hematological parameters [43,44]. Anemia poses particular challenges when women undergo surgery, particularly for the treatment of their HMB: around 23% of women scheduled for an elective hysterectomy or myomectomy have anemia [39].…”

The association between intraoperative cell salvage and red blood cell transfusion in cardiac surgery – an observational study in a patient blood management centre

“…cardiac surgery), irrespective of underlying risk factors or type of cardiac surgery. All patients screened by the anaemia walk-in clinic are supplemented with iron/folic acid/vitamin B 12 if required [12]. Physiological conditions of haemostasis (body temperature > 36°C; pH > 7.2; Ca 2+ > 1.1 mmoL L -1 ), use of tranexamic acid, minimally invasive techniques, and point-of-care diagnostics or management of coagulopathy are ensured during surgery among other interventions.…”

Implementation of an anaemia walk‐in clinic: Feasibility and preliminary data from the Orthopedic University Hospital

“…14 In this context, an anaemia walk-in clinic was established in 2014 at the University Hospital in Frankfurt. 15,16 Overall, IV iron supplementation in iron-deficient anaemia (IDA) patients undergoing major non-orthopaedic surgery was associated with a decreased transfusion rate and LOS. 16 Even though the effectiveness of an anaemia walk-in clinics has been demonstrated, 10,[15][16][17][18] anaemia walk-in clinics have only been implemented in a few hospitals so far.…”

“…So far, more than 100 individual PBM measures have been defined based on the broad interdisciplinary fields and temporal application 14 . In this context, an anaemia walk‐in clinic was established in 2014 at the University Hospital in Frankfurt 15,16 . Overall, IV iron supplementation in iron‐deficient anaemia (IDA) patients undergoing major non‐orthopaedic surgery was associated with a decreased transfusion rate and LOS 16 .…”

“…Even though Hb values are measured before surgery, preoperative anaemia management is not performed in every hospital. In this study, we present the results of the implementation of an anaemia walk-in clinic at the OUF based on the example of the University Hospital in Frankfurt 15,16. In addition, theusefulness of Ret-He in preoperative anaemia management was evaluated.…”