Pre-operative iron therapy in anaemic surgical patients

University College London

  • Project led by University College London and NHS Blood and Transport.
  • Based at Queen Elizabeth Hospital in King’s Lynn.
  • Aimed to reduce the need for blood transfusion in anaemic patients undergoing major elective surgery.
  • Treated anaemic patients with a single pre-operative dose of intravenous iron and measured the effect on haemoglobin levels, patient outcomes and length of hospital stay.

The team at University College London examined whether using intravenous iron can prevent the need for pre-operative blood transfusion in anaemic patients who are undergoing major elective surgery. The project explored:

  • the incidence of anaemia in patients undergoing elective inpatient surgery
  • whether anaemia independently affects patient outcomes
  • whether pre-operative intravenous iron therapy can raise haemoglobin levels and correct anaemia before surgery.

The team first examined the link between anaemia in elective surgical patients, the need for blood transfusion and length of hospital stay. They then treated anaemic patients with a single pre-operative dose of the Ferinject intravenous iron formulation and measured the results.

Who was involved

The research was led from UCL's Research Department of General Surgery and involved colleagues from the pre-admission clinic, blood transfusion team and hospital information services. The project was in collaboration with NHS Blood and Transplant.

Findings

Although Ferinject is 246% more expensive than another treatment (Venofer), it can generate savings in nursing costs, hospital costs, overall hospital costs and primary care costs. It also contributes to fewer hospital visits for patients, fewer delays and shorter hospital stays

Challenges

The biggest obstacle the team faced was having to move the location of the project. The initial plan was to run the study at University College London Hospital, but the use of medicines committee would not accept Ferinject into the hospital’s formulary. 

Data collection was another challenge: the pre-admission clinic and hospital information services databases only matched in 50-60% of cases, and neither linked to the blood transfusion database.

Further reading

Learning report

Shine: Improving the value of local healthcare services

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