title: Correction of iron-deficiency anaemia in colorectal surgery reduces perioperative transfusion rates: A before and after study.
abstract: BACKGROUND
  Preoperative anaemia is a risk factor for poorer postoperative outcomes and many colorectal cancer patients have iron-deficiency anaemia. The aim of this study was to assess if a preoperative iron-deficiency anaemia management protocol for elective colorectal surgery patients helps improve detection and treatment of iron-deficiency, and improve patient outcomes.
  
  
  METHODS
  Retrospective data was collected from 95 consecutive patients undergoing colorectal cancer surgery to establish baseline anaemia correction rates and perioperative transfusion rates. A new pathway for early detection of iron-deficiency anaemia, and treatment with intravenous iron replacement, for colorectal cancer patients was then developed and implemented. Data from 81 patients was collected prospectively post-implementation to assess the impact of the pathway.
  
  
  RESULTS
  Pre-intervention data showed anaemic patients were seventeen times more likely to require perioperative transfusion than non-anaemic patients (95% CI 1.9-151.0, p = 0.011). Post-intervention, fifteen patients with iron-deficiency were treated with either intravenous (n = 8) or oral iron (n = 7). Mean Day 3 postoperative haemoglobin levels were significantly lower in patients with uncorrected anaemia (9.5 g/dL, p = 0.004); those patients whose anaemia was corrected by iron replacement therapy preoperatively had similar postoperative results to non-anaemic patients (10.93 g/dL vs 11.4 g/dL, p = 0.781). Postoperative transfusion rates remained high at 38% in patients with uncorrected anaemia, compared to 0% in corrected anaemia and 3.5% in non-anaemic patients.
  
  
  CONCLUSIONS
  Introduction of an iron-deficiency anaemia management pathway has resulted in improved perioperative haemoglobin levels, with a reduction in perioperative transfusion, in elective colorectal patients. Implementation of this pathway could result in similar outcomes across other categories of surgical patients.
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Building, Glasgow Royal Infirmary, G4 0ET, Glasgow, Scotland, UK. Electronic address: edelquinn@rcsi.ie.
authors.forename: Edel M
authors.initials: EM
authors.lastname: Quinn
authors.affiliation: Pharmacy Department, Glasgow Royal Infirmary, G4 0SF, Glasgow, Scotland, UK.
authors.forename: Ellen
authors.initials: E
authors.lastname: Meland
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Building, Glasgow Royal Infirmary, G4 0ET, Glasgow, Scotland, UK.
authors.forename: Stacy
authors.initials: S
authors.lastname: McGinn
authors.affiliation: Department of Colorectal Surgery, Queen Elizabeth Building, Glasgow Royal Infirmary, G4 0ET, Glasgow, Scotland, UK.
authors.forename: John H
authors.initials: JH
authors.lastname: Anderson
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000628:therapy*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D065187:Controlled Before-After Studies; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014131:Trace Elements / Q000008:administration & dosage*
chemical_list: D014131:Trace Elements; D007501:Iron
keywords: Anaemia; Colorectal cancer; Intravenous iron; Iron-deficiency; Surgery