An international consensus statement on the management of postoperative anaemia after major surgical procedures

Abstract

Despite numerous guidelines on the management of anaemia in surgical patients, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in the postoperative period. A number of experienced researchers and clinicians took part in a two-day expert workshop and developed the following consensus statement. After presentation of our own research data and local policies and procedures, appropriate relevant literature was reviewed and discussed. We developed a series of best-practice and evidence-based statements to advise on patient care with respect to anaemia and iron deficiency in the postoperative period. These statements include: a diagnostic approach to iron deficiency and anaemia in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up that is easy to implement. Available data allow the fulfilment of the requirements of Pillar 1 of Patient Blood Management. We urge national and international research funding bodies to take note of these recommendations, particularly in terms of funding large-scale prospective, randomised clinical trials that can most effectively address the important clinical questions and this clearly unmet medical need.

Management of Perioperative Iron Deficiency Anemia

“…Preoperative anemia, female gender, smaller body surface area, perioperative blood loss, and postoperative blunted erythropoiesis are the main factors contributing to postoperative anemia [14]. There are limited published data extant on the consequences of postoperative anemia in the recovery phase from surgery, but an association with poorer outcomes (prolonged recovery, early postoperative myocardial infarction, increased mortality, and likelihood of readmission) has been suggested [14]. …”

“…For elective procedures, this may lead to the postponement of surgery with the intent of anemia treatment with the goal of resolution [5]. For nonelective procedures, any available time should be used to initiate treatment, which ultimately can be started or continued in the postoperative period [5, 14]. It is recommended es­tablishing a patient blood management expert group in every hospital performing major surgical procedures, where a clear perioperative anemia management pathway should be in place (Fig.…”

“…It is recommended es­tablishing a patient blood management expert group in every hospital performing major surgical procedures, where a clear perioperative anemia management pathway should be in place (Fig. 1, 2) [5, 14]. …”

“… A pathway for postoperative anemia management [adapted from reference 14]. Hb, hemoglobin; ID, iron deficiency; Post­OP, postoperative; RBCT, red blood cell transfusion.…”

“…As for postoperative oral iron, a review of 7 RCTs, including 804 orthopedic and cardiac surgery patients, showed that high-dose oral iron therapy (100–300 mg elemental iron/day) was not better than placebo in correcting postoperative anemia and/or reducing transfusion requirements, and was associated with significant gastrointestinal side effects [14] (see online suppl. Table 3).…”