Real-world results of the implementation of preoperative anaemia clinic with intravenous iron therapy for treating iron-deficiency anaemia: a propensity-matched case-control study

Abstract

Background: Preoperative anaemia is associated with blood transfusion and longer hospital length of stay.Preoperative iron deficiency anaemia (IDA) can be treated with oral or intravenous (IV) iron. IV iron can raise haemoglobin faster compared with oral iron. However, its ability to reduce blood transfusion and length of stay in clinical trials is inconclusive. This study aims to compare blood transfusion and hospital length of stay between anemic patients who received preoperative IV iron versus standard care, after implementation of a protocol in 2017 to screen patients for preoperative IDA, and its treatment with IV iron.Methods: Retrospective before-after cohort study comparing 89 patients who received IV iron preoperatively in 2017, with historic patients who received oral iron therapy (selected by propensity score matching (PSM) from historic cohort of 7,542 patients who underwent surgery in 2016). Propensity score was calculated using ASA status, age, gender, surgical discipline, surgical risk and preoperative haemoglobin concentration. Both 1:1 and 1:2 matching were performed as sensitivity analysis.Results: After PSM, there was no statistically significant difference in distribution of preoperative clinical variables. There was no significant difference in proportion of cases requiring transfusion nor a difference in average units transfused per patient. IV iron cohort stayed in hospital on average 8.0 days compared to non-IV iron cohort 14.1-15.1 days (P=0.006, P=0.013 respectively). Average time from IV iron therapy to surgery was 10.5 days.Conclusions: Preoperative IV iron therapy for patients with IDA undergoing elective surgery may not reduce perioperative blood transfusion, but this could be due to the short time between therapy and surgery.Implementation of IV iron therapy may reduce hospital length of stay compared to standard care for anemic patients, although this may be enhanced by concomitant improvement in perioperative care.

Hospital transfusion service operations during the SARS‐CoV‐2 pandemic: Lessons learned from the AABB hospital survey in preparation for the next infectious disease outbreak

“…Respondents were not asked to identify surgeries that were impacted explicitly. Yet, this finding could provide insight into the evaluation and treatment of preoperative anemia (another patient blood management program component 23 ), the benefits of which might include decreased blood transfusions, not to mention improved outcomes and shorter length of hospital stay 24–28 . Notably, a recent randomized controlled trial showed that patients receiving iron supplementation were not transfused less blood compared to patients who did not receive iron up to 42 days before major abdominal surgery 29 …”

Intravenous Iron Preparations for Patients Undergoing Elective Surgery: A 2022 Update

“…25 One nonrandomized study was published in 2022, 26 while 5 non-randomized studies were published in 2021. [27][28][29][30][31] Five of the non-randomized studies were retrospective cohort studies that used historical patient data in their analysis. [26][27][28][29][30] One non-randomized study was a multicenter prospective cohort study that used prospectively collected patient data.…”

“…[27][28][29][30][31] Five of the non-randomized studies were retrospective cohort studies that used historical patient data in their analysis. [26][27][28][29][30] One non-randomized study was a multicenter prospective cohort study that used prospectively collected patient data. 31 When reported, patient follow-up time varied across studies depending on the outcome being reported, but ranged from 21 days to 3 months.…”

“…Six SRs [16][17][18][19][20][21] including 3 with meta-analysis (MA), 16,17,19 4 RCTs, [22][23][24][25] 6 non-randomized studies, [26][27][28][29][30][31] and 1 evidence-based guideline 32 was included in this report.…”

“…19 The included RCTs were conducted in Hong Kong, 22 Norway, 23 Egypt, 24 and Singapore. 25 The included non-randomized studies were conducted in Denmark, 26 Singapore, 27 the UK, 28,30 Canada, 29 and Germany. 31 The included evidence-based guideline was conducted in Canada.…”