What is the clinical evidence from this study?

Study design: Observational. Population: Preoperative anaemia and iron deficiency (n=2191). Intervention: Intravenous iron supplementation vs. No iron supplementation. Primary outcome: Total number of transfused red blood cell units (p=0.03).

April 7, 2022Open Access

The impact of intravenous iron supplementation in elderly patients undergoing major surgery

Key Result

Intravenous iron supplementation significantly reduced the median number of transfused red blood cell units compared to no treatment in elderly patients with preoperative anaemia and iron deficiency.

Study Design

Type

Observational (n=2,191)

Multicenter

Structured PICO

Does preoperative intravenous iron supplementation improve haemoglobin levels and reduce red blood cell transfusions in elderly patients with iron deficiency anaemia undergoing major surgery?

Population

2,191 elderly patients (≥65 years) scheduled for major surgery with high risk of blood loss, screened for preoperative anaemia and iron deficiency.

Exposure

Intravenous iron supplementation (ferric carboxymaltose 500 mg or 1,000 mg) administered preoperatively.

Comparator

Non-treated anaemic patients and non-anaemic patients.

Outcome

Haemoglobin (Hb) increment and red blood cell (RBC) transfusion rate.

Preoperative intravenous iron supplementation in elderly surgical patients with iron deficiency anaemia significantly increases haemoglobin levels and reduces the need for red blood cell transfusions.

Main Result

Absolute Event Rate: 0% vs 1%

p-value: p=0.03

Limitations

Retrospective observational design
Inability to distinguish anaemia of chronic inflammation or kidney disease from iron deficiency
Irregular physiotherapy assessments may have underestimated the time to mobility
Large proportion of patients received iron only 1 day before surgery
Did not address comorbidities such as renal impairment, diabetes, COPD, or frailty which influence length of stay

Abstract

Abstract Background Age and preoperative anaemia are risk factors for poor surgical outcome and blood transfusion. The aim of this study was to examine the effect of iron supplementation in iron-deficient (ID) elderly patients undergoing major surgery. Method In this single-centre observational study, patients ≥ 65 years undergoing major surgery were screened for anaemia and ID. Patients were assigned to the following groups: A − (no anaemia); A − ,ID + ,T + (no anaemia, iron-deficient, intravenous iron supplementation); A + (anaemia); and A + ,ID + ,T + (anaemia, iron-deficient, intravenous iron supplementation). Results Of 4,381 patients screened at the anaemia walk-in clinic, 2,381 (54%) patients were ≥ 65 years old and 2,191 cases were included in analysis. The ID prevalence was 63% in patients with haemoglobin (Hb) 10 days before surgery, respectively. Hb increased by 0 (-0.1; 0) g/dl with iron supplementation 1–5 days before surgery, 0.2 (-0.1; 0.5) g/dl with iron supplementation 6–10 days before surgery, and 0.2 (-0.2; 1.1) g/dl with supplementation > 10 days before surgery ( p 0.5 g/dl. The number of transfused red blood cell units was significantly lower in patients supplemented with iron (0 (0; 3)) compared to non-treated anaemic patients (1 (0; 4)) ( p = 0.03). Patients with iron supplementation > 6 days before surgery achieved mobility 2 days earlier than patients with iron supplementation < 6 days. Conclusions Intravenous iron supplementation increases Hb level and thereby reduces blood transfusion rate in elderly surgical patients with ID anaemia.

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