Department of Colorectal Surgery, Queen Elizabeth Building, Glasgow Royal Infirmary, G4 0ET, Glasgow, Scotland, UK.
Pharmacy Department, Glasgow Royal Infirmary, G4 0SF, Glasgow, Scotland, UK.
Int J Surg. 2017 Feb;38:1-8. doi: 10.1016/j.ijsu.2016.12.029. Epub 2016 Dec 21.
Preoperative anaemia is a risk factor for poorer postoperative outcomes and many colorectal cancer patients have iron-deficiency anaemia. The aim of this study was to assess if a preoperative iron-deficiency anaemia management protocol for elective colorectal surgery patients helps improve detection and treatment of iron-deficiency, and improve patient outcomes.
Retrospective data was collected from 95 consecutive patients undergoing colorectal cancer surgery to establish baseline anaemia correction rates and perioperative transfusion rates. A new pathway for early detection of iron-deficiency anaemia, and treatment with intravenous iron replacement, for colorectal cancer patients was then developed and implemented. Data from 81 patients was collected prospectively post-implementation to assess the impact of the pathway.
Pre-intervention data showed anaemic patients were seventeen times more likely to require perioperative transfusion than non-anaemic patients (95% CI 1.9-151.0, p = 0.011). Post-intervention, fifteen patients with iron-deficiency were treated with either intravenous (n = 8) or oral iron (n = 7). Mean Day 3 postoperative haemoglobin levels were significantly lower in patients with uncorrected anaemia (9.5 g/dL, p = 0.004); those patients whose anaemia was corrected by iron replacement therapy preoperatively had similar postoperative results to non-anaemic patients (10.93 g/dL vs 11.4 g/dL, p = 0.781). Postoperative transfusion rates remained high at 38% in patients with uncorrected anaemia, compared to 0% in corrected anaemia and 3.5% in non-anaemic patients.
Introduction of an iron-deficiency anaemia management pathway has resulted in improved perioperative haemoglobin levels, with a reduction in perioperative transfusion, in elective colorectal patients. Implementation of this pathway could result in similar outcomes across other categories of surgical patients.
术前贫血是术后不良预后的一个危险因素，许多结直肠癌患者存在缺铁性贫血。本研究旨在评估择期结直肠手术患者的缺铁性贫血管理方案是否有助于提高缺铁的检出率和治疗率，并改善患者结局。
回顾性收集 95 例连续接受结直肠癌手术的患者数据，以确定基线贫血纠正率和围手术期输血率。然后为结直肠癌患者制定并实施了一种新的缺铁性贫血早期检测和静脉铁剂替代治疗的途径。实施后前瞻性收集 81 例患者的数据，以评估该途径的影响。
干预前数据显示，贫血患者围手术期输血的可能性是非贫血患者的 17 倍（95%CI 1.9-151.0，p=0.011）。干预后，15 例缺铁性贫血患者接受了静脉（n=8）或口服铁剂（n=7）治疗。未纠正贫血患者的术后第 3 天血红蛋白水平明显较低（9.5g/dL，p=0.004）；术前通过铁剂纠正贫血的患者术后结果与非贫血患者相似（10.93g/dL 与 11.4g/dL，p=0.781）。未纠正贫血患者的术后输血率仍高达 38%，而纠正贫血患者为 0%，非贫血患者为 3.5%。
引入缺铁性贫血管理途径可改善择期结直肠患者的围手术期血红蛋白水平，减少围手术期输血。在其他类别的手术患者中实施该途径可能会产生类似的结果。
