The Important Role for Intravenous Iron in Perioperative Patient Blood Management in Major Abdominal Surgery

Froessler, Bernd; Palm, Peter; Weber, Ingo; Hodyl, Nicolette A.; Singh, Rajvinder; Murphy, Elizabeth

doi:10.1097/sla.0000000000001646

Cited by 292 publications

(323 citation statements)

References 46 publications

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“…Preoperative iron deficiency is associated with higher perioperative transfusion rates . Controlled clinical trials have demonstrated that correction of iron deficiency with or without improvement in preoperative anaemia resulted in lower rates of RBCT . These controlled studies had protocols governing patient management which might include carefully defined timelines between screening for, and correction of, iron deficiency in relation to elective surgery, predefined RBCT triggers and other aspects of PBM.…”

Section: Discussionsupporting

confidence: 86%

“…Our results indicate PIT negated the effect of iron deficiency on postoperative RBCT, leading to lower odds of perioperative RBCT. While this is consistent with the findings in controlled clinical trials , our study differs in that our cohort were transfused at the discretion of the treating surgeons/anaesthetists, rather than following predefined trial criteria for postoperative RBCT. Due to the nature of the study, it was not possible to determine the trigger(s) for RBCT in every case.…”

Section: Discussionmentioning

confidence: 50%

“…When the guideline was released, it was noted that there were no published studies that assessed the efficacy of non‐transfusion interventions such as iron therapy in preoperative patients. Since then, however, some controlled trials assessing the efficacy of PIT with or without concomitant erythropoietin administration have been reported .…”

Section: Introductionmentioning

confidence: 99%

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

Hong

Sieradzki

Pollock

et al. 2018

ISBT Science Series

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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.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Hong

Sieradzki

Pollock

et al. 2018

ISBT Science Series

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“…In the previously mentioned study by Hirasawa et al ., it was demonstrated that sarcopenic patients showed significantly lower haemoglobin levels than non‐sarcopenic patients. As recently shown in a randomized controlled trial, patients with iron‐deficiency anaemia undergoing major open abdominal surgery showed significantly reduced blood transfusions and length of hospital stay, when administered perioperative intravenous iron . Perioperative iron transfusion could therefore complement the nutritional support programme in sarcopenic patients with iron‐deficiency anaemia.…”

Section: Discussionmentioning

confidence: 78%

Sarcopenia as a comorbidity‐independent predictor of survival following radical cystectomy for bladder cancer

Mayr

Gierth

Zeman

et al. 2018

J cachexia sarcopenia muscle

107

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BackgroundA multicentre study was conducted to investigate the impact of sarcopenia as an independent predictor of oncological outcome after radical cystectomy for bladder cancer.MethodsIn total, 500 patients with available digital computed tomography scans of the abdomen obtained within 90 days before surgery were identified. The lumbar skeletal muscle index was measured using pre‐operative computed tomography. Cancer‐specific survival (CSS) and overall survival (OS) were estimated using Kaplan–Meier curves. Predictors of CSS and OS were analysed by univariable and multivariable Cox regression models.ResultsBased on skeletal muscle index, 189 patients (37.8%) were classified as sarcopenic. Patients with sarcopenia were older compared with their counterparts (P = 0.002), but both groups were comparable regarding to gender, comorbidity, tumor, node, metastasis (TNM) stage, and type of urinary diversion (all P > 0.05). In total, 234 (46.8%) patients died, and of these, 145 (29.0%) died because of urothelial carcinoma of the bladder. Sarcopenic patients had significantly worse 5 year OS (38.3% vs. 50.5%; P = 0.002) and 5 year CSS (49.5% vs. 62.3%; P = 0.016) rates compared with patients without sarcopenia. Moreover, sarcopenia was associated independently with both increased all‐cause mortality (hazard ratio, 1.43; 95% confidence interval 1.09–1.87; P = 0.01) and increased cancer‐specific mortality (hazard ratio, 1.42; 95% confidence interval, 1.00–2.02; P = 0.048). Our results are limited by the lack of prospective frailty assessment.ConclusionsSarcopenia has been shown to be an independent predictor for OS and CSS in a large multicentre study with patients undergoing radical cystectomy for bladder cancer.

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“…The availability of an easy‐to‐follow, diagnostic algorithm is desirable . Intravenous iron is efficacious, safe and should be used in patients in whom oral iron is not tolerated, or if surgery is planned in less than 4‐6 weeks after the diagnosis of iron deficiency . It is notable that most effective increments of Hb‐levels (∆Hb of 1·5 and 3·9 g/dl) can be reached when intravenous iron was administered between 2 and 4 weeks before surgery .…”

Section: Anaemia Management Before An Interventionmentioning

confidence: 99%

Patient blood management

Meybohm

Choorapoikayil

Regaei

et al. 2018

ISBT Science Series

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More than 30% of the world's population are anaemic with serious medical consequences. Red blood cell transfusion is the mainstay to correct anaemia, but it is also one of the top five overused procedures, and carries its own risks. Patient blood management (PBM) is a patient‐centred and multidisciplinary approach to manage anaemia, minimize iatrogenic blood loss and harness tolerance to anaemia to improve patient outcome. Despite resolution, 63·12 of the World Health Organization in 2010 endorsing PBM and current guidelines with evidence‐based recommendations on the use of diagnostic and therapeutic measures, PBM is still not implemented in many hospitals. Here, we present a short review of recent developments in the field of PBM.

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The Important Role for Intravenous Iron in Perioperative Patient Blood Management in Major Abdominal Surgery

Abstract: Supplemental Digital Content is available in the text

Cited by 292 publications

References 46 publications

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

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

Sarcopenia as a comorbidity‐independent predictor of survival following radical cystectomy for bladder cancer

Patient blood management

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