The Effect of Preoperative Intravenous Iron Therapy on Postdischarge Incidence of Anemia in Anemic Patients Undergoing Colorectal Cancer Surgery

Year 2023, Volume: 76 Issue: 4, 340 - 347, 05.04.2024

Hakan Yılmaz , Ayşegül Güven

Abstract

Objectives: Iron deficiency anemia is quite common due to impaired iron metabolism and increased blood losses inherent in colorectal cancer. The primary objective of this retrospective research; is to investigate the effect of preoperative iron treatment on the incidence of postoperative anemia in colorectal cancer patients whose anemia was detected in the preoperative anesthesia evaluation and who were undergoing to surgery shortly after intravenous iron treatment.

Materials and Methods: Data of 40 patients who underwent colorectal cancer surgery between January 1 and August 31, 2023 were included in the study. Demographic characteristics of the patients, preoperative hemoglobin and ferritin levels, administered intravenous iron dose, amount of intraoperative bleeding, and hemoglobin levels measured in the early postoperative period, at discharge, and at the 1st and 3rd months after discharge were recorded retrospectively. Numerical variables were presented as mean ± SD, and categorical variables were presented as number and Data were analyzed with Student’s t-test and Mann-Whitney U test. Pearson’s r and Spearman’s rho test were used for correlation analysis. Alpha error level was accepted as 5% for statistical significance.

Results: Preoperative hemoglobin and ferritin levels were 11.9 g/dL and 42.9 ng/mL, respectively. Preoperative anemia prevalence was found to be 80%. When the patients’ postoperative and discharge hemoglobin levels were compared with their preoperative hemoglobin levels, about an average of 1 and 1.8 g/dL decrease was detected, respectively. The incidence of postoperative anemia was found to be 54.5%. It was observed that there was a positive correlation between postoperative hemoglobin level and intravenous iron dose. Pre - Postoperative hemoglobin difference showed positive correlation with ClassIntra scores, Clavien-Dindo scores and the amount of fluid administered intraoperatively. It was observed that patients who were found to be anemic in the third month needed more erythrocyte suspension throughout their hospitalization.

Conclusion: Anemia should be treated at any stage of the perioperative period in colorectal cancer surgery patients. It is necessary to investigate
the multifactorial etiology and pathophysiology underlying anemia for each patient.

Keywords

Anemia , Enhanced Recovery After Surgery , Colorectal Cancer

Ethical Statement

Etik Kurul Onayı: Ankara Üniversitesi Tıp Fakültesi Klinik Araştırmaları Etik Kurulu’ndan onay (AUTFKAEK no: 2023/570, Prof. Dr. Ergün) alındı. Hasta Onayı: Retrospektif çalışmadır. Hakem Değerlendirmesi: Editörler kurulunun dışından olan kişiler tarafından değerlendirilmiştir.

Kolorektal Kanser Cerrahisi Geçiren Anemik Hastalarda Preoperatif İntravenöz Demir Tedavisinin Taburculuk Sonrası Anemi İnsidansına Etkisi

Abstract

Amaç: Kolorektal kanserin doğasında olan bozulmuş demir metabolizması ve artan kan kayıpları nedeniyle demir eksikliği anemisi oldukça sık görülmektedir. Bu araştırmanın primer amacı; preoperatif anestezi değerlendirmesinde anemisi tespit edilen ve intravenöz demir tedavisi uygulandıktan kısa süre sonra cerrahiye alınan kolorektal kanserli hastalarda cerrahi öncesinde uygulanan demir tedavisinin postoperatif anemi insidansına yarattığı etkiyi ortaya koymaktır.

Gereç ve Yöntem: Araştırmaya 01 Ocak-31 Ağustos 2023 tarihleri arasında kolorektal kanser cerrahisi geçiren 40 hastanın verisi dahil edildi. Hastaların demografik özellikleri, preoperatif hemoglobin ve ferritin düzeyleri, uygulanan intravenöz demir dozu, intraoperatif kanama miktarı, postoperatif erken dönemde, taburculukta ve taburculuktan sonraki 1. ve 3. ay ölçülen hemoglobin düzeyleri retrospektif olarak kaydedildi. Sayısal değişkenler ortalama ± SS, kategorik değişkenler sayı ve % ile sunuldu. Veriler Student’s t-testi ve Mann-Whitney U testi ile analiz edildi. Korelasyon analizi için Pearson’s r ve Spearman’s rho testi kullanıldı. İstatistiksel anlamlılık için alfa hata düzeyi %5 kabul edildi.

Bulgular: Preoperatif hemoglobin ve ferritin düzeyleri sırasıyla 11,9 g/dL ve 42,9 ng/mL idi. Preoperatif anemi prevelansı %80 bulundu. Hastaların postoperatif ve taburculuk hemoglobin düzeyleri, preoperatif hemoglobin düzeyleri karşılaştırıldığında sırasıyla yaklaşık ortalama 1 ve 1,8 g/dL’lik azalma tespit edildi. Postoperatif anemi insidansı %54,5 bulundu. Postoperatif hemoglobin düzeyi ile intravenöz demir dozunun pozitif korelasyonunun olduğu görüldü. Pre - Postoperatif hemoglobin farkı; ClassIntra, Clavien-Dindo skorları ve intraoperatif uygulanan sıvı miktarı ile pozitif korelasyon gösterdi. Üçüncü ayda anemik saptanan hastaların hastane yatışları boyunca daha fazla eritrosit süspansiyonuna ihtiyacı olduğu görüldü.

Sonuç: Kolorektal kanser cerrahisi hastalarında perioperatif dönemin herhangi bir aşamasında anemi tedavi edilmelidir. Her hasta için aneminin altında yatan çok faktörlü etiyolojinin ve patofizyolojinin araştırılması gereklidir.

Keywords

Anemi , Ameliyat Sonrası Gelişmiş İyileşme , Kolorektal Kanser

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