Pre-operative iron therapy: where are we?

Pre-operative anaemia affects one-third of patients undergoing major surgery and is associated with worse perioperative and postoperative outcomes; including length of hospital stay, allogeneic blood transfusion, morbidity and mortality. Iron deficiency is the commonest cause of anaemia, and associative data suggests that preoperative correction of iron deficiency anaemia could improve postoperative patient outcomes. However, data from randomised controlled trials (RCTs) do not appear to support the routine use of iron therapy to treat preoperative anaemia. We present a literature review of large RCTs examining the efficacy of preoperative intravenous iron. We discuss the observation that although preoperative intravenous iron treatment can increase haemoglobin concentration prior to surgery in certain patient groups, the data do not clarify whether there is a direct benefit to patients. We address that preoperative intravenous iron may not be a feasible option and highlight the need to explore the mechanism and management of iron deficiency anaemia in surgical patients.