Pre-operative IV iron in anemia patients may not cut complications after surgery: Lancet

Before undergoing major surgery, 30-50 percent of individuals suffer from anemia. Preoperative anemia is linked to an increased need for blood transfusions, postoperative problems, and poor patient outcomes following surgery. International guidelines advocate  use of intravenous iron to treat anemia in patients prior to surgery.

However, a research found that providing intravenous iron prior to elective major abdominal surgery had little effect in individuals with anemia. Preoperative intravenous iron was not superior to placebo in reducing mortality or need for blood transfusion when administered to patients with anaemia 10-42 days before elective major abdominal surgery.

The findings of this work was published in The Lancet, in the month of September 2021.

With the objective to determine if intravenous iron given to patients with anemia before to major abdominal surgery is advantageous in terms of lowering transfusion rates, postoperative complications, hospital stay and re-admission, and increasing quality of life outcomes, Toby Richards and team carried out this study. 

Between September 2013 and September 2018, 46 hospitals in England, Scotland, and Wales participated in the study. A multicenter, double-blind, randomized, controlled Phase III clinical study comparing placebo (normal saline) to intravenous iron (intravenous ferric carboxymaltose 1000 mg). A secure web-based service was used for randomization and treatment allocation.

The administration of intravenous iron raised preoperative Hb levels but had no influence on the risk of blood transfusion or mortality, or blood transfusion rates, as compared to placebo. There was no change in the number of postoperative problems or hospital stays. At the 8-week follow-up, the intravenous iron group showed higher Hb levels. In the placebo group, there were 71 re-admissions to the hospital for postoperative problems, compared to 38 re-admissions in the intravenous iron group. There were no differences in mortality (two deaths per group at 30 days post-op) or any of the prespecified safety end goals or severe adverse events between the groups.

In conclusion, with no solid evidence on benefit of intravenous iron prior to surgery, the effect of iron replacement on recovery from surgical anaemia, as well as the relationship with lower re-admission to the hospital for complications, should be studied.

Reference:

Richards, T., Baikady, R. R., Clevenger, B., Butcher, A., Abeysiri, S., Chau, M., Swinson, R., Collier, T., Dodd, M., Dyck, L. V., Macdougall, I., Murphy, G., Browne, J., Bradbury, A., & Klein, A. (2021). Preoperative intravenous iron for anaemia in elective major open abdominal surgery: the PREVENTT RCT. Health Technology Assessment, 25(11), 1–58. https://doi.org/10.3310/hta25110