Preoperative Iron Infusions May Prevent Anemia Better Than Blood Transfusions for Some Patients

Some patients with preoperative anemia have better outcomes if they get iron infusions before surgery rather than standard red blood cell transfusions, according to a study led by researchers at Johns Hopkins Medicine. The findings were published in Anesthesia & Analgesia.

Using data from the TriNetX Research Network, investigators compared outcomes among two groups of patients with preoperative iron-deficiency anemia (IDA): one group received preoperative intravenous (IV) iron (77,179 patients) while the other group received preoperative RBC transfusions (77,179 patients). They assessed rates of 30-day postoperative mortality, 30-day morbidity, postoperative hemoglobin levels, and the need for postoperative RBC transfusion.

Investigators found that patients who received preoperative IV iron had a lower risk of postoperative mortality (3.3% versus 5.2%, respectively) and a lower risk of postoperative complications (18.4% versus 24.1%, respectively). Both results were statistically significant. Additionally, patients treated with IV iron had higher hemoglobin levels 30 days after surgery (10.1 ± 1.8 g/dL versus 9.4 ± 1.7 g/dL) and required fewer postoperative RBC transfusions (4.9% versus 16.4%).

According to investigators, the results suggest that patients receiving iron infusions may recover more quickly and fully from their surgical procedures without any added complications that may arise from a blood transfusion.

“Anemia is incredibly common, especially in surgical patients, and until recently the default treatment has been blood transfusions prior to the procedure,” said Steven Frank, MD, study co-author and professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. “However, our retrospective study showed a benefit of iron infusions over preoperative blood transfusions in decreasing morbidity and mortality, increasing hemoglobin and decreasing the need for blood transfusions.”

The researchers hope their findings will encourage more widespread use of preoperative iron infusions in surgical patients. In the future, they aim to examine whether oral iron supplements garner the same outcomes as infusions.