Postoperative Results After Patient Blood Management with Intravenous Iron Treatment Implementation for Preoperative Anemia: Prospective Cohort Study of 1294 Colorectal Cancer Patients

Abstract

Background: PA is frequent in CRC patients and known to be detrimental to surgical outcomes. PBM systems promote rational use of blood products and PA treatment with IVI, which could potentially improve postoperative results and the need for RBCT. Objective: To evaluate the effectiveness of Intravenous Iron (IVI) within a Patient Blood Management (PBM) pathway in Colorectal Cancer (CRC) patients with Preoperative Anemia (PA). To analyze surgical results after treatment and the need for Red Blood Cell Transfusion (RBCT) after surgery. Methods: Cohort study of CRC patients between 2012 and 2018, divided into groups: non-anemic patients (Hemoglobin Hb > 13 g/dL, Group 1), mildly anemic patients (Hb 12-13 mg/dL, Group 2), and patients treated with IVI (Hb < 12 mg/dL or Hb 12-13 mg/dL with risk factors, Group 3). Effectiveness of IVI treatment measured based on differences in Hb changes. Surgical complications were assessed and compared among groups, as well as the RBCT rate. The latter was also compared between Group 3 patients and those receiving preoperative RBCT. Results: Group 3 presented with a baseline Hb of 9.9 (+/- 1.5) mg/dL with an increase of 1.2 (+/- 1.9) mg/dL after treatment, which endured until discharge. Clavien-Dindo III-IV complications were 6.5%, and 30-day Mortality was 1.4% in all the series, without differences among Groups. RBCT rate in Group 3 patients was 21.6%, significantly lower than that of patients receiving preoperative RBCT (32.6%). Conclusions: IVI is a safe and effective measure for a fast PA correction in CCR patients and could potentially reduce postoperative RBCT rates.