Observational study of pre‐operative intravenous iron given to anaemic patients before elective cardiac surgery

Anaesthesia - Tập 76 Số 5 - Trang 639-646 - 2021
Carol Evans1, Rhys Jones1, Georgina Phillips1, Giles Greene2, Mabel Phillips3, R. Morris‐Clarke1
1University Hospital of Wales, Cardiff, UK
2Department of Statistics, Cardiff University, Cardiff, UK
3Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff UK

Tóm tắt

SummaryCardiac surgical patients with anaemia experience increased morbidity and mortality. Iron deficiency is the most common cause of pre‐operative anaemia in this group. We designed and implemented the Cardiff Pathway, a pre‐assessment and treatment pathway to identify cardiac surgical patients with anaemia and iron deficiency. Patients identified with anaemia and/or iron deficiency (Hb < 130 g.l‐1 and ferritin < 100 μg.l‐1) were offered intravenous iron infusion 20 mg.kg‐1 pre‐operatively. Treatment success was defined as Hb ≥ 130g.l‐1 on the day of surgery. We analysed data from 447 patients: 300 (67%) were not anaemic; 75 (17%) were anaemic and treated with intravenous iron; and 72 (16%) were anaemic and not treated. Haemoglobin concentration increased in successfully treated anaemic patients by a mean (95%CI) of 17 (13–21) g.l‐1 and they received a median (IQR [range]) of 0 (0–2 [0–15]) units of blood peri‐operatively. Transfusion was avoided in 54% of the successfully treated anaemic patients, which was significantly more than the unsuccessfully treated anaemic (22%, p = 0.005) and untreated anaemic (28%, p = 0.018) patients and similar to non‐anaemic patients who received a median (IQR [range] of 0 (0–1 [0–16])) units of blood and, 63% avoided transfusion). Mean (95%CI) Hb fell between pre‐assessment and surgery in the untreated anaemic (‐2 (0 to ‐4) g.l‐1) and non‐anaemic groups (‐2 (‐1 to ‐3) g.l‐1). Twenty‐one (7%) of the non‐anaemic group became newly anaemic waiting for surgery. The Cardiff Pathway reliably identified patients with anaemia and iron deficiency. Anaemic patients who had their Hb restored to normal after treatment required less blood peri‐operatively and over half of them required no transfusion at all.

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Anaesthesia

Tập 76 Số 5

639-646

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