Efficacy of a pre-operative anaemia clinic in patients undergoing elective abdominal cancer surgery.

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Acta Anaesthesiologica Scandinavica Pub Date : 2024-11-01 Epub Date: 2024-07-10 DOI:10.1111/aas.14495

Kristine Elisabeth Bagge Barsballe, Morten Bundgaard-Nielsen, Birgitte Ruhnau, Jens Georg Hillingsøe, Eske Kvanner Aasvang, Øivind Jans

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引用次数: 0

Abstract

Background: Pre-operative iron deficiency anaemia (IDA) is common in patients undergoing elective major abdominal surgery and is associated with increased risk of perioperative complications. However, widespread implementation of pre-operative anaemia management is lacking. Guidelines recommend investigation of anaemia preferably 4-6 weeks before surgery to allow time for correction. However, this is not always feasible in abdominal cancer surgery with short time to surgery and may be influenced by concomitant chemotherapy. The objective of this study was to assess the efficacy of implementing a pre-operative screening and treatment programme for IDA in elective abdominal cancer surgery patients, with short duration to surgery and concomitant use of chemotherapy.

Methods: All patients scheduled for elective abdominal cancer surgery with IDA were included. Anaemia was defined according to the World Health Organization-criteria and iron deficiency as a transferrin saturation <0.20. The primary outcome was change in haemoglobin (Hb) between iron infusion and surgery in patients receiving pre-operative intravenous iron infusion.

Results: Of 178 diagnosed IDA patients 134 (75%) received intravenous iron, 103 pre-operatively (58%) at median day 17 (interquartile range: 9-27) before surgery while 31 (17%) received post-operative intravenous iron treatment. The pre-operative Hb increased 0.89 g/dL (95% CI: 0.64-1.13, p < .001) compared to a decrease of 0.4 g/dL (95% CI: 0.19-0.58, p < .001) in 75 patients not treated pre-operatively. Patients diagnosed with severe anaemia had the largest pre-operative Hb increase. Iron infusion >2 weeks pre-operatively resulted in a greater Hb increment of 1.13 g/dL (95% CI: 0.81-1.45) compared to iron infusion ≤2 weeks before surgery 0.48 g/dL (95% CI: 0.16-0.81). Hb increased by 0.64 g/dL (95% CI 0.19-1.21) in patients receiving chemotherapy ≤31 days prior to surgery.

Conclusion: In patients scheduled for abdominal cancer surgery, including in patients with concomitant chemotherapy, pre-operative IDA management is feasible and results in a significant pre-operative Hb increase compared to patients not treated. On the day of surgery 25% patients treated pre-operatively were no longer anaemic.

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为接受腹部癌症择期手术的患者开设术前贫血门诊的效果。

背景：术前缺铁性贫血（IDA）在接受择期腹部大手术的患者中很常见，与围手术期并发症风险增加有关。然而，目前尚未广泛实施术前贫血管理。指南建议最好在手术前 4-6 周进行贫血检查，以便有时间进行纠正。然而，对于手术时间较短的腹部癌症手术来说，这并不总是可行的，而且可能会受到同时进行的化疗的影响。本研究旨在评估对手术时间短且同时接受化疗的择期腹部癌症手术患者实施术前 IDA 筛查和治疗计划的效果：方法：纳入所有计划接受腹部癌症择期手术并伴有IDA的患者。贫血的定义符合世界卫生组织的标准，缺铁的定义符合转铁蛋白饱和度：在 178 名确诊的 IDA 患者中，134 人（75%）接受了静脉注射铁剂治疗，其中 103 人（58%）在术前第 17 天（四分位间范围：9-27）接受了术前铁剂治疗，31 人（17%）在术后接受了静脉注射铁剂治疗。与术前≤2 周输注铁剂 0.48 g/dL (95% CI: 0.16-0.81)相比，术前 2 周输注铁剂可使血红蛋白增加 1.13 g/dL (95% CI: 0.81-1.45)。手术前≤31天接受化疗的患者血红蛋白增加了0.64 g/dL (95% CI 0.19-1.21)：结论：对于计划接受腹部癌症手术的患者，包括同时接受化疗的患者，术前IDA管理是可行的，与未接受治疗的患者相比，术前Hb显著增加。手术当天，25%接受术前治疗的患者不再贫血。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Anaesthesiologica Scandinavica 医学-麻醉学

CiteScore

4.30

自引率

9.50%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Acta Anaesthesiologica Scandinavica publishes papers on original work in the fields of anaesthesiology, intensive care, pain, emergency medicine, and subjects related to their basic sciences, on condition that they are contributed exclusively to this Journal. Case reports and short communications may be considered for publication if of particular interest; also letters to the Editor, especially if related to already published material. The editorial board is free to discuss the publication of reviews on current topics, the choice of which, however, is the prerogative of the board. Every effort will be made by the Editors and selected experts to expedite a critical review of manuscripts in order to ensure rapid publication of papers of a high scientific standard.