Correcting preoperative iron deficiency as part of patient blood management in the ‘real world’: results of an audit on an Australian cohort

Abstract

Background The perioperative module of the Australian Patient Blood Management guidelines recommended preoperative iron therapy for surgical patients with, or at risk of, iron deficiency anaemia. After implementing a preoperative haemoglobin optimization programme in our institution, an audit was undertaken to evaluate the benefit of preoperative iron therapy in ‘real world’ clinical practice. Methods Elective major surgery patients assessed in surgical pre‐admission clinics from 1 July 2013 to 30 June 2014 were screened for iron deficiency and anaemia. Those who were iron deficient (ferritin <30 μg/l), regardless of haemoglobin level, received either daily oral iron supplementation until day of surgery or intravenous iron polymaltose 1 g preoperatively (intervention group). Control patients who were not iron deficient were matched to the intervention group using propensity scores based on age, sex and surgical unit. The primary end‐point was the proportion of patients requiring perioperative red cell transfusion in intervention and control groups. Results One hundred and fourteen patients (8·75%) had iron deficiency. Ninety‐three patients received preoperative iron therapy, 17 (18·3%) of whom required red cell transfusions postoperatively. Of the 332 control patients, 71 (21·4%) required red cell transfusion. After adjusting for preoperative haemoglobin and time from screening to surgery, the odds of red cell transfusion were significantly lower in the intervention group compared to controls (odds ratio: 0·512, 95% confidence interval: 0·268–0·977; P = 0·04). Conclusion Preoperative iron therapy was associated with reduced need for postoperative red blood cell transfusion in elective major surgery patients who were initially iron deficient.

<p>Preoperative Anemia Screening and Treatment Practices in Patients Having Total Joint Replacement Surgery: A Retrospective, Observational Audit</p>

“…Within this population, anemia screening and preoperative optimisation can have a significant impact on reducing the length of hospital stay, and the probability of a patient requiring a blood transfusion. 15,16 This study reports compliance levels with recommended preoperative anemia screening and treatment practices, and the impact on blood transfusions and length of stay. 17…”

Anaemia in patients undergoing major bowel surgery – Prevalence and current practice: A public and private institution experience

“…Patients should have at least a full blood count (FBC), ferritin test, and C-reactive protein (CRP) at least one week before surgery (DHHSV, BM 2016). Limited Australian data have been published since the 2015 study in the bowel surgery population (Hong et al 2018). As there is a lack of clinical data on the effect of perioperative anaemia in bowel surgery patients and uncertainty around the implementation of PBM in the local setting, close monitoring of current practice is vital to guide PBM implementation and identify areas for improvement.…”