title: Pre-operative haemoglobin levels and iron status in a large multicentre cohort of patients undergoing major elective surgery.
abstract: 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-1or < 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.
authors.affiliation: Peri-operative Transfusion Medicine, School of Medicine, Málaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Muñoz
authors.affiliation: Anesthesiology, Corporació Sanitarìa Parc Taulí, Sabadell, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Laso-Morales
authors.affiliation: Internal Medicine, University Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Gómez-Ramírez
authors.affiliation: Cardiology, University Hospital Mar-Esperança, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Cadellas
authors.affiliation: Obstetrics and Gynaecology, Regional University Hospital, Málaga, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Núñez-Matas
authors.affiliation: Blood and Tissue Bank of Navarra, Osansubidea, Pamplona, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: García-Erce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007501:Iron / Q000378:metabolism*; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care
chemical_list: D006454:Hemoglobins; D007501:Iron
keywords: anaemia; iron deficiency; iron sequestration; iron stores; major surgery