Correction of iron-deficiency anaemia in colorectal surgery reduces perioperative transfusion rates: A before and after study

Quinn, Edel; Meland, Ellen; McGinn, Stacy; Anderson, John H.

doi:10.1016/j.ijsu.2016.12.029

Cited by 51 publications

(69 citation statements)

References 29 publications

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“…8,12 During the study period, there was no formal perioperative blood transfusion protocol. As reported previously, 13 between June 2016 and June 2017 a preoperative iron replacement protocol was in place for the relatively small number of patients found to have true iron-deficient anemia.…”

Section: Patientsmentioning

confidence: 98%

Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

et al. 2019

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Background. The present study investigated relationships between perioperative blood transfusion, postoperative systemic inflammatory response, and outcomes following surgery for colorectal cancer. Methods. Data were recorded for patients (n = 544) undergoing potentially curative, elective surgery for colorectal cancer at a single center between 2012 and 2017. Transfusion history was obtained retrospectively from electronic records. Associations between blood transfusion, postoperative C-reactive protein (CRP), albumin, hemoglobin, complications, cancer-specific survival and overall survival (OS) were assessed using propensity score matching (n =116). Results. Of 544 patients, the majority were male (n =294, 54%), over 65 years of age (n =350, 64%), and with colonic (n =347, 64%) node-negative disease (n =353, 65%). Eighty-six patients (16%) required perioperative blood transfusion. In the unmatched cohort, blood transfusion was associated with higher median postoperative day (POD) 3 CRP {143 [interquartile range (IQR) 96-221 mg/L] vs. 120 (IQR 72-188 mg/L); p = 0.004}, lower median POD 3 albumin [24 (IQR 20-26 g/L) vs. 27 (IQR 24-30 g/L); p \ 0.001], more postoperative complications [odds ratio (OR) 3.28, 95% confidence interval (CI) 2.03-5.29] and poorer OS [hazard ratio (HR) 3.18, 95% CI 2.08-4.84]. In the propensity score matched cohort, blood transfusion was similarly associated with higher median POD 3 CRP [130 (IQR 93-196 mg/L) vs. 113 (IQR 66-173 mg/L); p = 0.046], lower median POD 3 albumin [24 (IQR 20-26 g/L) vs. 26 (IQR 24-30 g/L); p \ 0.001], more postoperative complications (OR 2.91, 95% CI 1.36-6.20) and poorer OS (HR 2.38, 95% CI 0.99-5.73). Conclusions. Perioperative blood transfusion was associated with postoperative inflammation, complications, and poorer survival in patients undergoing colorectal cancer surgery, with and without propensity score techniques. A significant proportion of patients undergoing surgery for colorectal cancer require allogeneic blood transfusion in the perioperative period. 1 Such transfusions are associated with infective postoperative complications and anastomotic leak. 2,3 They are also associated with disease recurrence, 3,4 and this effect is even greater in the presence of infective complications. 5 Therefore, it has long been hypothesized that allogeneic blood transfusion might impair the host adaptive immune response to both pathogens and circulating or micrometastatic tumor cells. 6 There is increasing evidence that an exaggerated postoperative systemic inflammatory response following surgery for colorectal cancer is associated with postoperative complications and long-term survival. 7 Furthermore, there is some observational evidence that modulation of this response can improve both short-8 , and long-term outcomes. 9 It may be that perioperative blood transfusion and postoperative complications have a negative impact on oncologic outcomes via a common pathway, the systemic inflammatory response. 10

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Section: Patientsmentioning

confidence: 98%

Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

et al. 2019

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“…Anaemia, defined by the World Health Organization (WHO) as a haemoglobin (Hb) level <12 g/dl in women and <13 g/dl in men , is a major predictor for higher perioperative transfusion requirements, prolonged length of stay in hospital and morbidity . The preoperative management of anaemia in turn has been demonstrated to increase Hb levels as well as to reduce perioperative transfusion requirements in patients undergoing surgery . In fact, implementing pathways to diagnose and treat preoperative anaemia in general as well as to provide iron supplementation to patients suffering from iron deficiency anaemia (IDA) are recommendations provided by the 2018 Frankfurt Consensus Conference on PBM .…”

Section: Introductionmentioning

confidence: 99%

Programmes for the management of preoperative anaemia: audit in ten European hospitals within the PaBloE (Patient Blood Management in Europe) Working Group

et al. 2019

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.nations had national guidelines. In six of the ten participating hospitals, preoperative anaemia management was organized by anaesthetists. Diagnostics and treatment focused on iron deficiency anaemia which, in most hospitals, was corrected with intravenous iron.Conclusion Implementation and approaches of preoperative anaemia management vary across Europe with a primary focus on treating iron deficiency anaemia. Findings of this survey motivated the hospitals involved to critically evaluate their practice and may also help other hospitals interested in PBM to develop action plans for diagnosis and management of preoperative anaemia.

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“…En nuestro estudio, se objetiva que la aplicación de un protocolo de corrección de anemia preoperatoria antes de la CCR electiva según las pautas de un protocolo ERAS aumenta de forma estadísticamente significativa la administración de hierro intravenoso en el periodo preoperatorio (3 (2,23%) vs 31 (25,6%), p < 0,001), por lo que disminuye el número de pacientes trasfundidos (31 (22,96%) vs 15 (12,4%), p 0,028) así como el número total de concentrados de hematíes trasfundidos (3 ± 1,57 vs 1,8 ± 0,56, p < 0,001) durante el ingreso hospitalario. Además, disminuye la estancia hospitalaria con respecto a los pacientes operados de forma tradicional sin la aplicación del protocolo ERAS, sin aumentar las complicaciones, el número de reingresos ni la mortalidad, coincidiendo con el resultado de otros estudios [16][17][18][19][20] .…”

Section: Discussionunclassified

Resultados De La Implantación De Un Protocolo De Corrección De Anemia Preoperatoria en La Recuperación Intensificada De Cirugía Colorrectal Electiva

Olivares

et al. 2020

Rev. Cirugia

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Introducción: Los protocolo ERAS recomiendan la detección y optimización de la anemia preoperatoria. El objetivo principal es valorar si la implantación de un protocolo de corrección de anemia preoperatoria en cirugía colorrectal electiva con un protocolo ERAS (grupo ERAS) reduce las transfusiones con respecto a un grupo de pacientes operado de la misma patología previo a su implantación (grupo preERAS). Objetivos secundarios: valorar estancia hospitalaria, complicaciones, y reingresos a los 30 días tras el alta. Material y métodos: Comparamos los primeros 121 pacientes consecutivos que participaron en un protocolo ERAS con un protocolo corrección de anemia preoperatoria con los 135 previos a su implantación. Se consideraron resultados significativos p<0,05. Resultados: Se redujo el número de pacientes transfundidos en el grupo ERAS (31 (22,96%) vs 15 (12,4%), p=0,028) y el número total de concentrados de hematíes transfundidos (3 ± 1,57 vs 1,8 ± 0,56, p <0,001)) con la aplicación del protocolo. No se encontraron diferencias estadísticamente significativas en los pacientes que recibieron hierro oral, pero sí en los que recibieron hierro intravenoso (3 vs 31, p <0,001). Se redujo la estancia hospitalaria (11±3,8 vs 9,8±3,7, p=0,018), sin aumentar la tasa de complicaciones ni los reingresos a los 30 días. Conclusión: La aplicación de un protocolo de optimización de anemia preoperatoria en pacientes sometidos a cirugía colorrectal electiva siguiendo las guías ERAS redujo el número total de pacientes transfundidos, el número de concentrados de hematíes trasfundidos y la estancia hospitalaria.

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Correction of iron-deficiency anaemia in colorectal surgery reduces perioperative transfusion rates: A before and after study

Cited by 51 publications

References 29 publications

Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

Programmes for the management of preoperative anaemia: audit in ten European hospitals within the PaBloE (Patient Blood Management in Europe) Working Group

Resultados De La Implantación De Un Protocolo De Corrección De Anemia Preoperatoria en La Recuperación Intensificada De Cirugía Colorrectal Electiva

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