Perioperative anaemia is recognised as having a significant impact on patient outcomes in major surgery, with iron deficiency being the commonest cause of this. As well as being expensive, blood transfusion may result in worse outcomes for patients. There is therefore increasing recognition of the importance of optimising patients’ haematological status throughout the entire surgical journey to minimise both anaemia and related blood transfusion. Appropriate preoperative iron supplementation is one key part of this pathway, with intravenous (IV) iron potentially being more effective in cases of a short preoperative window, for example cancer surgery. As such, there has been a developing trend for using IV iron therapy in patients that had iron deficiency anaemia prior to expedited surgery.
However, the PREVENTT study recently suggested a more limited benefit from preoperative IV iron therapy. Whilst iron levels appeared to increase for the operative day and later postoperative days, this did not translate into reduced transfusion rates or improved mortality. As such, this may ultimately lead to a change in practice in IV iron usage, especially given the cost and logistical challenges that were associated with its use.
Anecdotally, the practice of perioperative anaemia management has notable variability between trusts within the Northwest of England. This is especially the case for less well established perioperative therapies such as IV iron. This project aims to explore the current systems in place for managing preoperative anaemia in the Northwest of England.
However, the PREVENTT study recently suggested a more limited benefit from preoperative IV iron therapy. Whilst iron levels appeared to increase for the operative day and later postoperative days, this did not translate into reduced transfusion rates or improved mortality. As such, this may ultimately lead to a change in practice in IV iron usage, especially given the cost and logistical challenges that were associated with its use.
Anecdotally, the practice of perioperative anaemia management has notable variability between trusts within the Northwest of England. This is especially the case for less well established perioperative therapies such as IV iron. This project aims to explore the current systems in place for managing preoperative anaemia in the Northwest of England.
Goals
- Understand the local systems in place across the North West for managing preoperative anaemia, with a focus on perioperative iron therapy.
- Share examples of effective systems for effectively managing preoperative anaemia, with potential for subsequent service development opportunities.
- Provide educational opportunities for participating trainees around the related aspects of perioperative care, as well as QI methodology.
The project will entail a survey of all hospital sites across the North West region. The focus will be on elective surgical patients and the identification, investigation and management of anaemia preoperatively.
The project is planned to consist of several phases, each building on the work of the previous phase(s), and allowing variable engagement of sites depending on specific local set-up.
Whilst they will feed into each other, each phase will still be a discrete project in its own right, providing useful information and output.
Phase 1 - Collection of local site information
Phase 2 - Survey of local staff
Phase 3 - Snapshot review of service provision (potential)
The project is planned to consist of several phases, each building on the work of the previous phase(s), and allowing variable engagement of sites depending on specific local set-up.
Whilst they will feed into each other, each phase will still be a discrete project in its own right, providing useful information and output.
Phase 1 - Collection of local site information
Phase 2 - Survey of local staff
Phase 3 - Snapshot review of service provision (potential)
We are really excited to be able to publish the results of phase 1 of the project. These are available below. Thank you to everyone that has contributed to this project!
| ironman_-_phase_1_results.pdf |
We are now working on finalising phase 2 of the project. If you are interested in getting involved please get in touch through the link below.
Resources
| IronMan SOP |
| IronMan Phase 1 Questionnaire |
