Preoperative iron supplementation is better for treating iron deficiency anemia

Although preoperative anemia is associated with poor perioperative outcomes, the benefits of treatment with iron replacement therapy versus red blood cell transfusion remain uncertain.

Una E. Choi, of the Johns Hopkins University School of Medicine in Baltimore, and colleagues conducted a retrospective analysis from 2003 to 2023 to examine trends in preoperative treatment of IDA among surgical patients diagnosed with IDA within three months before surgery. A cohort of 77,179 patients with preoperative IDA who were treated with intravenous iron alone without red blood cell transfusion was compared with a cohort of 77,179 patients who received preoperative red blood cell transfusion without iron supplementation.

The researchers found that preoperative intravenous iron was associated with a lower risk of postoperative mortality (3.3% vs. 5.2%) and a lower risk of postoperative composite morbidity compared with red blood cell transfusion (relative risks, 0.63 and 0.76, respectively). Intravenous iron was associated with higher 30-day postoperative hemoglobin levels (10.1 ± 1.8 vs. 9.4 ± 1.7 g/dL) and a reduced rate of postoperative red blood cell transfusion (relative risk, 0.30) compared with preoperative red blood cell transfusion.

“This change in practice represents a promising opportunity to further improve outcomes and reduce the number of preventable blood transfusions and their associated costs,” the authors write.