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

A Randomized Controlled Trial
Bernd Froessler, MD, MClinSc,y Peter Palm, MD, Ingo Weber, MD, Nicolette A. Hodyl, PhD,z
Rajvinder Singh, MBBS, MPhil,§ and Elizabeth M. Murphy, PhDjj

Abstract

Objective

To determine if preoperative intravenous (IV) iron improves
outcomes in abdominal surgery patients.
Summary Background Data: Preoperative iron deficiency anemia (IDA)
occurs frequently; however if left untreated, increases the risk of blood
transfusion allogeneic blood transfusion (ABT). Limited evidence supports
IDA treatment with preoperative IV iron. This randomized controlled trial
aimed to determine whether perioperative IV iron reduced the need for ABT.

Methods:

Between August 2011 and November 2014, 72 patients with IDA
were assigned to receive either IV iron or usual care. The primary endpoint
was incidence of ABT. Secondary endpoints were various hemoglobin (Hb)
levels, change in Hb between time points, length of stay, iron status, morbidity,
mortality, and quality of life 4 weeks postsurgery.
Results: A 60%reduction in ABTwas observed in the IViron group compared
with the usual care group (31.25% vs 12.5%). Hb values, although similar at
randomization, improved by 0.8 g/dL with IViron compared with 0.1 g/dL with
usual care (P¼0.01) by the day of admission.The IViron group had higherHb4
weeks after discharge compared with the usual care group (1.9 vs 0.9 g/dL, P¼
0.01), and a shorter length of stay (7.0 vs 9.7 d, P ¼ 0.026). There was no
difference in discharge Hb levels, morbidity, mortality, or quality of life.

Conclusions:

Administration of perioperative IViron reduces the need for blood
transfusion, and is associated with a shorter hospital stay, enhanced restoration of
iron stores, and a higher mean Hb concentration 4 weeks after surgery.
Keywords: intravenous iron, iron deficiency anemia, outcomes, red blood
cell transfusion, surgery

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