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. 2025 Jun 3;17(11):1877.
doi: 10.3390/cancers17111877.

Intravenous Iron for Perioperative Anaemia in Colorectal Cancer Surgery: A Nested Cohort Analysis

Dominic Fritche  1   2 , Frances Wensley  1   3   4 , Yanika L Johnson  5 , Callum Robins  6 , Mai Wakatsuki  6 , Imogen C Fecher-Jones  1   3   6 , Lisa Sheppard  6 , Malcolm A West  1   2   6 , Alice Aarvold  6 , Mark R Edwards  1   3   6 , Michael P W Grocott  1   3   6 , James Plumb  1   6 , Denny Z H Levett  1   3   6
Affiliations

Intravenous Iron for Perioperative Anaemia in Colorectal Cancer Surgery: A Nested Cohort Analysis

Dominic Fritche et al. Cancers (Basel). .

Abstract

Background/Objectives: Iron deficiency anaemia (IDA) is a common complication in patients with colorectal cancer presenting for surgery. Perioperative IDA is associated with increased post-operative mortality and morbidity. The impact on clinical outcomes for the active management of anaemia before surgery, with treatments such as intravenous (IV) iron, is uncertain. Methods: We performed a single-centre nested cohort study, analysing prospectively collected data from patients with colorectal cancer who were treated with IV iron prior to elective major abdominal surgery. Cox proportional hazard models were used to quantify the effect of anaemia treatment on length of stay. Other outcomes, including transfusion rates, were estimated using logistic regression analyses. Models were adjusted for age, sex, comorbidities and surgical details. Results: The length of stay was longer for patients with untreated anaemia compared to patients without anaemia (adjusted hazard ratio, HR 0.66 [95% confidence interval, CI 0.45, 0.95]). For patients with anaemia, the length of stay was shorter in those treated when compared to those not treated (adjusted HR 0.59 [95% CI 0.45, 0.78]). Patients with untreated anaemia had higher transfusion rates than patients with treated anaemia (adjusted odds ratio, OR 0.35 [95% CI 0.18, 0.66]) and non-anaemic patients (adjusted odds ratio, OR 0.20 [95% CI 0.07, 0.55]). Conclusions: This study suggests that treating iron deficiency anaemia with IV iron pre-operatively reduces length of stay and transfusion rates in colorectal cancer patients.

Keywords: allogenic blood transfusion; anaemia; colorectal cancer; gastrointestinal surgery; haemoglobin; intravenous iron; iron deficiency; length of stay; perioperative care.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Comparison of mean haemoglobin levels across the perioperative period.
Figure 2
Figure 2
The median length of stay and the likelihood of remaining in hospital across anaemic treated, not treated and not anaemic patient groups. IQR = interquartile range; CI = confidence interval; * adjusted for age and sex.
See this image and copyright information in PMC

References

    1. Muñoz M., Laso-Morales M.J., Gómez-Ramírez S., Cadellas M., Núñez-Matas M.J., García-Erce J.A. Pre-operative haemoglobin levels and iron status in a large multicentre cohort of patients undergoing major elective surgery. Anaesthesia. 2017;72:826–834. doi: 10.1111/anae.13840. - DOI - PubMed
    1. Deng Y., Weng M., Zhang J. Preoperative anaemia and long-term survival in patients undergoing colorectal cancer surgery: A retrospective cohort study. World J. Surg. Oncol. 2023;21:122. doi: 10.1186/s12957-023-03005-w. - DOI - PMC - PubMed
    1. Myles P.S., Richards T., Klein A., Wood E.M., Wallace S., Shulman M.A., Martin C., Bellomo R., Corcoran T.B., Peyton P.J., et al. Postoperative anaemia and patient-centred outcomes after major abdominal surgery: A retrospective cohort study. Br. J. Anaesth. 2022;129:346–354. doi: 10.1016/j.bja.2022.06.014. - DOI - PubMed
    1. Baron D.M., Hochrieser H., Posch M., Metnitz B., Rhodes A., Moreno R.P., Pearse R.M., Metnitz P. Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients. Br. J. Anaesth. 2014;113:416–423. doi: 10.1093/bja/aeu098. - DOI - PubMed
    1. Fowler A.J., Ahmad T., Phull M.K., Allard S., Gillies M.A., Pearse R.M. Meta-analysis of the association between preoperative anaemia and mortality after surgery. J. Br. Surg. 2015;102:1314–1324. doi: 10.1002/bjs.9861. - DOI - PubMed

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