Moving into the 'iron age': Perioperative Anaemia service at a tertiary oncology centre

ABSTRACT

Background Perioperative anaemia is independently associated with adverse outcomes such as increased length of stay, complications and mortality1. Around 40% of patients presenting for major surgery are anaemic2. The most common cause of preoperative anaemia is iron deficiency, which can be treated with iron therapy. Identifying patients with anaemia during the perioperative pathway allows for optimisation and prevention of blood transfusions. A key focus of the Perioperative Quality Improvement Programme (PQIP) in the UK is the management of perioperative anaemia3 and recommendations have been made for institutions to set up a perioperative anaemia management service. Methods Data was retrospectively collected from electronic patient health records, which are maintained by the anaemia and research nurses at our centre. We analysed the relevant data to assess the delivery of the perioperative anaemia service from 2018-2020. Results We identified 1391 patients who received IV iron infusions from 2018-2020. 65% of the patients were females. Iron (III) Isomaltoside (Monofer) was the choice of IV iron preparation during all three years, however, there was an increasing use of Ferric Carboxymaltose (Ferrinject) in 2020. Overall number if iron infusions increased steadily and doubled from 2018 to 2020 (see Image 1a). Across the 3 years there was an 18% increase in perioperative iron infusions in surgical patients. This was seen most predominantly in patients having major intra-abdominal surgery (54% increase) (see image 1b). Due to the COVID-19 pandemic restrictions, the iron infusion service was modified to deliver iron infusions post-operatively. Subsequently, a significant proportion of surgical patients (71%) received iron infusions in the post-operative period. Discussion In our centre a perioperative anaemia and iron infusion service has been established for almost four years. This service is coordinated by a consultant anaesthetist, an anaemia specialist nurse and perioperative anaesthesia fellows. It is feasible to operate a perioperative anaemia service for several surgical specialities with the intention of improving patient outcomes. Our preliminary data shows an improvement in haemoglobin levels following iron infusion. However, we await further analysis to assess whether this has resulted in a reduction in blood transfusions. A well-coordinated service at our centre will help guide quality improvement projects and future research.