Perioperative Iron Deficiency in Patients Scheduled for Major Elective Surgeries: A French Prospective Multicenter Cross-Sectional Study

Abstract

BACKGROUND: The management of perioperative iron deficiency is a component of the concept of patient blood management. The objective of this study was to update French data on the prevalence of iron deficiency in patients scheduled for major surgery. METHODS: The CARENFER PBM study was a prospective cross-sectional study in 46 centers specialized in orthopedic, cardiac, urologic/abdominal, or gynecological surgery. The primary end point was the prevalence of iron deficiency at the time of surgery (D-1/D0) defined as serum ferritin <100 µg/L and/or transferrin saturation (TSAT) <20%. RESULTS: A total of 1494 patients (mean age, 65.7 years; women, 49.3%) were included from July 20, 2021 to January 3, 2022. The prevalence of iron deficiency in the 1494 patients at D-1/D0 was 47.0% (95% confidence interval [CI], 44.5–49.5). At 30 days after surgery, the prevalence of iron deficiency was 45.0% (95% CI, 42.0–48.0) in the 1085 patients with available data. The percentage of patients with anemia and/or iron deficiency increased from 53.6% at D-1/D0 to 71.3% at D30 (P < .0001), mainly due to the increase of patients with both anemia and iron deficiency (from 12.2% at D-1/D0 to 32.4% at D30; P < .0001). However, a treatment of anemia and/or iron deficiency was administered preoperatively to only 7.7% of patients and postoperatively to 21.7% (intravenous iron, 14.2%). CONCLUSIONS: Iron deficiency was present in half of patients scheduled for major surgery. However, few treatments to correct iron deficiency were implemented preoperatively or postoperatively. There is an urgent need for action to improve these outcomes, including better patient blood management.

Management of perioperative iron deficiency anemia as part of patient blood management in France: A budget impact model‐based analysis based on real world data

“…One of the limitations of the observational study is that the proportion of ID patients is underestimated compared to what is observed in the literature 18,28 . This may be since diagnosis of iron deficiency was not routinely done in the study hospitals.…”

“…One of the limitations of the observational study is that the proportion of ID patients is underestimated compared to what is observed in the literature. 18,28 This may be since diagnosis of iron deficiency was not routinely done in the study hospitals. It is likely that the proportion of ID patients diagnosed would be higher with the implementation of a PBM program protocolizing a systematic diagnosis of this condition.…”

“…To overcome this underestimation, data from the literature were used to estimate the proportion of ID patients in France, considering a very conservative hypothesis (i.e., 75% of ID), 18 we could have based our hypothesis on more recent data. 28 In addition, we do not know whether (and if, to what degree) a change in the ID-prevalence and patient treatment ratio would be associated with a change in savings. We were neither able to differentiate the savings according to the cause of anemia (pure ID or functional ID).…”

“…It is likely that the proportion of ID patients diagnosed would be higher with the implementation of a PBM program protocolizing a systematic diagnosis of this condition. To overcome this underestimation, data from the literature were used to estimate the proportion of ID patients in France, considering a very conservative hypothesis (i.e., 75% of ID), 18 we could have based our hypothesis on more recent data 28 . In addition, we do not know whether (and if, to what degree) a change in the ID‐prevalence and patient treatment ratio would be associated with a change in savings.…”

Harnessing the potential of data‐driven strategies to optimise transfusion practice

“…A recent French cross-sectional study highlighted many deficiencies in perioperative anaemia management and correction of iron deficiency was poorly implemented. 15 Yet data increasingly support the effectiveness of PBM. For example, a recent study in Germany used the records of 1.2 million patients to report a reduction in transfusion rate of 13.7% in the group who underwent active PBM.…”