The important role for intravenous iron in perioperative patient blood management in major abdominal surgery: a randomized controlled trial.
In this study, patients with confirmed iron-deficiency anaemia (IDA) scheduled for major abdominal surgery (mostly gastrointestinal cancer resection) were randomly assigned to receive either intravenous (IV) iron or usual care. The primary endpoint was the incidence of allogeneic blood transfusion (ABT). Secondary endpoints were change in haemoglobin (Hb), length of stay, iron status, morbidity, mortality, and quality of life 4 weeks after surgery.
The authors intended to include 134 patients per group. However, the study was terminated early due to higher than expected rates of poor outcome in the usual-care group. Thus, only 72 eligible patients were finally enrolled, randomised and included in the analysis (IV iron, n = 40; usual care, n = 32).
Perioperative administration of IV iron reduced allogeneic blood transfusion rate (31.2% vs. 12.5%; P = 0.079) and index (2 [1–2] vs. 3 [2–5] units/transfused patient; P = 0.016). IV iron administration was also associated with a shorter hospital stay (7.0 vs. 9.7 days; P = 0.026), and enhanced restoration of iron stores (serum ferritin 248 vs. 99 ng/mL; P = 0.002), and a higher mean Hb concentration (12.2 vs. 11.1 g/dL; P < 0.001) 4 weeks after surgery. There was no difference in discharge Hb levels, morbidity, mortality or quality of life. These results are in line with previous observational and randomised studies [1-3] and clearly add to the growing body of evidence supporting the benefit of perioperative IV iron administration for treating IDA in patients undergoing major abdominal surgical procedures in which significant blood loss is expected. – Manuel Muñoz
References
1. Díaz Espallardo C, Laso Morales MJ, Colilles Calvet C, Mora López L, Roig Martínez I, Martínez Marín MT. [The multidisciplinary approach is useful for optimising preoperative haemoglobin in colorectal cancer surgery]. Cir Esp 2011;89:392-9.
2. Keeler BD, Simpson JA, Ng O, et al. An open-label, randomised controlled trial comparing the efficacy of intravenous and oral iron in the preoperative management of colorectal cancer anaemia: ivica trial. Gut 2015;64 Suppl 1:A339.
3. Calleja JL, Delgado S, Del Val A, et al. Ferric carboxymaltose reduces transfusions and hospital stay in patients with colon cancer and anemia. Int J Colorectal Dis 2016;31:543-51.
