Pre to post-operative IV iron infusion service : A paradigm shift in a post-COVID era

ABSTRACT

Background Preoperative anaemia affects a high proportion of patients undergoing major elective surgery and is associated with poor outcomes1. At our centre a pre-operative intravenous iron service was the established practice before the COVID-19 pandemic. However, the effects of the pandemic, social distancing and requirements for patient shielding resulted in a shift of our service to post-operative iron infusions. Methods A trust quality improvement service evaluation form was submitted for a retrospective analysis. We identified patients who had received IV iron infusion in the year 2020 via the patient electronic health records system. We aimed to look at the feasibility of a post-operative IV iron Infusion service. Results We retrieved data for 733 patients. The distribution of Iron infusions across our patient cohort is shown below in image 1. 594 ( 81%) infusions were for patients undergoing surgical procedures, whilst 139 (19%) were delivered for medical reasons in the outpatient setting. Image 2 shows the iron infusion distribution by surgical sub-specialities. The highest number of infusions were given to patients undergoing major intra-abdominal surgery (43.4%). In the surgical patient group, 171 received iron pre-operatively, and 423 received iron post-operatively (Image 3). Increments in Transferrin saturations and ferritin in both the pre and post-operative iron infusion groups were comparable. The increments in Haemoglobin (Hb) in both the groups were not significantly different ( P= 0.79). Discussion There is limited evidence to show the benefits of post-operative IV iron infusion2. Although our data did not reveal any significant difference in Hb increments in the pre or post-operative iron infusion groups, this demonstrates that a post-operative iron infusion service is feasible. Iron infusions can be successfully delivered to patients when it is not possible to do so pre-operatively. The non-significant increments could also be due to post-operative test values taken at discharge and not allowing enough time to have elapsed between blood test and an increment to have occurred. We noted that greater iron transfusions were administered in female patients and this could potentially be attributed to a lower starting Hb in this group. In the current climate, the benefits of post-operative iron infusion are favourable to prevent an additional patient visit, particularly when the demonstrated Hb increments are comparable to the pre-operative setting.