Pre‐operative haemoglobin levels and iron status in a large multicentre cohort of patients undergoing major elective surgery

M Muñoz, MJ Laso‐Morales, S Gómez‐Ramírez… - …, 2017 - Wiley Online Library
M Muñoz, MJ Laso‐Morales, S Gómez‐Ramírez, M Cadellas, MJ Núñez‐Matas…
Anaesthesia, 2017Wiley Online Library
Pre‐operative anaemia in patients undergoing major surgical procedures has been linked to
poor outcomes. Therefore, early detection and treatment of pre‐operative anaemia is
recommended. However, to effectively implement a pre‐operative anaemia management
protocol, an estimation of its prevalence and main causes is needed. We analysed data from
3342 patients (44.5% female) scheduled for either: elective orthopaedic surgery (n= 1286);
cardiac surgery (n= 691); colorectal cancer resection (n= 735); radical prostatectomy (n …
Summary
Pre‐operative anaemia in patients undergoing major surgical procedures has been linked to poor outcomes. Therefore, early detection and treatment of pre‐operative anaemia is recommended. However, to effectively implement a pre‐operative anaemia management protocol, an estimation of its prevalence and main causes is needed. We analysed data from 3342 patients (44.5% female) scheduled for either: elective orthopaedic surgery (n = 1286); cardiac surgery (n = 691); colorectal cancer resection (n = 735); radical prostatectomy (n = 362); gynaecological surgery (n = 203) or resection of liver metastases (n = 122). For both sexes, anaemia was defined by a haemoglobin level < 130 g.l−1; absolute iron deficiency by ferritin < 30 ng.ml−1 (< 100 ng.ml−1, if transferrin saturation < 20% or C‐reactive protein > 5 mg.l−1); iron sequestration by transferrin saturation < 20% and ferritin > 100 ng.ml−1; and low iron stores by transferrin saturation > 20% and ferritin 30–100 ng.ml−1. The overall prevalence of anaemia was 36%, with differences according to the type of surgery. Laboratory parameters allowing classification of iron status were available for 2884 patients. Among those with anaemia (n = 986), 677 (69%) were women, 608 (62%) presented with absolute iron deficiency, 101 (10%) with iron sequestration; and 150 (5%) with low iron stores. Iron status alterations were similar in women with haemoglobin < 130 g.l−1 or < 120 g.l−1. For those who were not anaemic (n = 1898), corresponding figures were 656 (35%), 621 (33%), 165 (9%) and 518 (27%), respectively. Anaemia was present in one‐third of patients undergoing major elective procedures. Over two‐thirds of anaemic patients presented with absolute iron deficiency or iron sequestration. Over half of non‐anaemic patients presented with absolute iron deficiency or low iron stores. We consider these data useful for planning pre‐operative management of patients scheduled for major elective surgery.
Wiley Online Library