BACKGROUND Preoperative anaemia affects one third of patients undergoing cardiac surgery and is associated with increased mortality and morbidity. Although it is recommended that perioperative teams should identify and treat patients with preoperative anaemia before surgery, introducing new treatment protocols can be challenging in surgical pathways. The aim of this study was to assess the feasibility and effectiveness of introducing a preoperative intravenous iron service as a national initiative in cardiac surgery. METHODS We performed a multicentre, stepped, observational study using the UK Association of Cardiothoracic Anaesthesia and Critical Care Research Network. The primary feasibility outcome was the ability to set up an anaemia and intravenous iron clinic at each site. The primary efficacy outcome was change in haemoglobin (Hb) concentration between intervention and operation. Secondary outcomes included blood transfusion and hospital stay. Patients with anaemia were compared with non-anaemic patients and with those who received intravenous iron as part of their routine treatment protocol. RESULTS Seven out of 11 NHS hospitals successfully set up iron clinics over 2 yr, and 228 patients were recruited into this study. Patients with anaemia who received intravenous iron were at higher surgical risk, were more likely to have a known previous history of iron deficiency or anaemia, had a higher rate of chronic kidney disease, and were slightly more anaemic than the non-treated group. Intravenous iron was administered a median (inter-quartile range, IQR [range]) of 33 (15-53 [4-303]) days before surgery. Preoperative intravenous iron increased [Hb] from baseline to pre-surgery; mean (95% confidence interval) change was +8.4 (5.0-11.8) g L-1 (P<0.001). Overall, anaemic compared with non-anaemic patients were more likely to be transfused (49% [59/136] vs 27% (22/92), P=0.001) and stayed longer in hospital (median days [IQR], 9 [7-15] vs 8 [6-11]; P=0.014). The number of days alive and at home was lower in the anaemic group (median days [IQR], 20 [14-22] vs 21 [17-23]; P=0.033). CONCLUSION The development of an intravenous iron pathway is feasible but appears limited to selected high-risk cardiac patients in routine NHS practise. Although intravenous iron increased [Hb], there is a need for an appropriately powered clinical trial to assess the clinical effect of intravenous iron on patient-centred outcomes.

中文翻译：

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心脏手术前的术前静脉铁剂：一项前瞻性多中心可行性研究。

背景技术术前贫血影响三分之一接受心脏手术的患者，并与死亡率和发病率增加相关。尽管建议围手术期团队在手术前识别和治疗术前贫血患者，但引入新的治疗方案可能对手术途径造成挑战。这项研究的目的是评估将术前静脉铁剂服务作为心脏外科手术的一项国家倡议的可行性和有效性。方法我们使用英国心胸麻醉和重症监护研究网络协会进行了多中心，分步，观察性研究。主要的可行性结果是在每个地点建立贫血和静脉铁诊疗所的能力。主要疗效结果是干预和手术之间血红蛋白（Hb）浓度的变化。次要结果包括输血和住院。将贫血患者与非贫血患者以及接受静脉铁剂作为常规治疗方案一部分的患者进行了比较。结果11家NHS医院中有7家在2年内成功建立了铁诊所，本研究招募了228名患者。接受静脉铁剂治疗的贫血患者的手术风险较高，较以前有已知的铁缺乏或贫血病史，慢性肾脏疾病的发生率更高，并且贫血的患者比未治疗的组略高。手术前33天（15-53 [4-303]）天给予静脉铁剂（四分位间距，IQR [范围]）。从基线到术前，术前静脉铁增加[Hb]。平均（95％置信区间）变化为+8.4（5.0-11.8）g L-1（P <0.001）。总体而言，与非贫血患者相比，贫血患者更容易输血（49％[59/136]比27％（22/92），P = 0.001），并且住院时间更长（中位天数[IQR]，9 [ 7-15]与8 [6-11]； P = 0.014）。贫血组存活和在家的天数较少（中位天数[IQR]，20 [14-22]对21 [17-23]； P = 0.033）。结论静脉铁途径的发展是可行的，但似乎仅限于常规NHS练习中选定的高危心脏病患者。尽管静脉铁剂增加[Hb]，但仍需要进行适当的临床试验来评估静脉铁剂对以患者为中心的预后的临床效果。