CORRECTION OF IRON-DEFICIENCY ANAEMIA IN COLORECTAL SURGERY REDUCES PERIOPERATIVE TRANSFUSION RATES.

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CORRECTION OF IRON-DEFICIENCY ANAEMIA IN COLORECTAL SURGERY REDUCES PERIOPERATIVE TRANSFUSION RATES.

Int J Surg. 2016 Dec 20;:

Authors: Quinn EM, Meland E, McGinn S, Anderson JH

Abstract
BACKGROUND: Preoperative anaemia is a risk factor for poorer postoperative outcomes and many colorectal cancer patients have iron-deficiency anaemia. The aim of this study was to assess if a preoperative iron-deficiency anaemia management protocol for elective colorectal surgery patients helps improve detection and treatment of iron-deficiency, and improve patient outcomes.
MATERIALS AND METHODS: Retrospective data was collected from 95 consecutive patients undergoing colorectal cancer surgery to establish baseline anaemia correction rates and perioperative transfusion rates. A new pathway for early detection of iron-deficiency anaemia, and treatment with intravenous iron replacement, for colorectal cancer patients was then developed and implemented. Data from 81 patients was collected prospectively post-implementation to assess the impact of the pathway.
RESULTS: Pre-intervention data showed anaemic patients were seventeen times more likely to require perioperative transfusion than non-anaemic patients (95% CI 1.9-151.0, p=0.011). Post-intervention, fifteen patients with iron-deficiency were treated with either intravenous (n=8) or oral iron (n=7). Mean Day 3 postoperative haemoglobin levels were significantly lower in patients with uncorrected anaemia (9.5g/dL, p=0.004); those patients whose anaemia was corrected by iron replacement therapy preoperatively had similar postoperative results to non-anaemic patients (10.93g/dL vs 11.4g/dL, p=0.781). Postoperative transfusion rates remained high at 38% in patients with uncorrected anaemia, compared to 0% in corrected anaemia and 3.5% in non-anaemic patients.
CONCLUSIONS: Introduction of an iron-deficiency anaemia management pathway has resulted in improved perioperative haemoglobin levels, with a reduction in perioperative transfusion, in elective colorectal patients. Implementation of this pathway could result in similar outcomes across other categories of surgical patients.

PMID: 28011177 [PubMed - as supplied by publisher]

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