Preoperative iron therapy: Where are we?

Preoperative anemia 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 most common cause of anemia, and associative data suggests that preoperative correction of iron deficiency anemia could improve postoperative patient outcomes. However, data from randomized controlled trials (RCTs) do not appear to support the routine use of iron therapy to treat preoperative anemia. 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 hemoglobin 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 anemia in surgical patients.