• Bernd Froessler, Peter Palm, Ingo Weber, Nicolette A Hodyl, Rajvinder Singh, and Elizabeth M Murphy.
• *Department of Anaesthesia, Lyell McEwin Hospital, South Australia, Australia†Discipline of Acute Care Medicine, University of Adelaide, South Australia, Australia‡The Robinson Research Institute, School of Medicine, University of Adelaide, South Australia, Australia§Department of Gastroenterology, Lyell McEwin Hospital, South Australia, Australia¶Discipline of Medicine, University of Adelaide, South Australia, Australia||Lyell McEwin Hospital, South Australia, Australia.
• Ann. Surg. 2016 Jul 1; 264 (1): 414641-6.

ObjectiveTo determine if preoperative intravenous (IV) iron improves outcomes in abdominal surgery patients.Summary Background DataPreoperative iron deficiency anemia (IDA) occurs frequently; however if left untreated, increases the risk of blood transfusion allogeneic blood transfusion (ABT). Limited evidence supports IDA treatment with preoperative IV iron. This randomized controlled trial aimed to determine whether perioperative IV iron reduced the need for ABT.MethodsBetween August 2011 and November 2014, 72 patients with IDA were assigned to receive either IV iron or usual care. The primary endpoint was incidence of ABT. Secondary endpoints were various hemoglobin (Hb) levels, change in Hb between time points, length of stay, iron status, morbidity, mortality, and quality of life 4 weeks postsurgery.ResultsA 60% reduction in ABT was observed in the IV iron group compared with the usual care group (31.25% vs 12.5%). Hb values, although similar at randomization, improved by 0.8 g/dL with IV iron compared with 0.1 g/dL with usual care (P = 0.01) by the day of admission. The IV iron group had higher Hb 4 weeks after discharge compared with the usual care group (1.9 vs 0.9 g/dL, P = 0.01), and a shorter length of stay (7.0 vs 9.7 d, P = 0.026). There was no difference in discharge Hb levels, morbidity, mortality, or quality of life.ConclusionsAdministration of perioperative IV iron reduces the need for blood transfusion, and is associated with a shorter hospital stay, enhanced restoration of iron stores, and a higher mean Hb concentration 4 weeks after surgery.

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