Effect of preoperative intravenous iron administration on transfusion outcomes in benign gynecologic surgery

Anemia is common in patients requiring gynecologic surgery and is associated with adverse surgical outcomes. The objective of this study was to evaluate the effect of preoperative intravenous (IV) iron administration on blood transfusion rates following hysterectomy and myomectomy and to share our experience establishing a standardized pre-procedure anemia evaluation (PPAE) pathway.

This was a retrospective cohort study at an academic tertiary care center including all patients who underwent benign hysterectomy or myomectomy between 2012 and 2021. The intervention reviewed was preoperative administration of IV iron and the implementation of a standardized PPAE pathway.

A total of 2842 patients were included, with 15% (n = 413) receiving preoperative IV iron. Patients who received IV iron were more likely to be younger (median 42 vs 45 years, P < 0.0001), identify as Black (52% vs 18%, P < 0.0001), and have a higher body mass index (median 30.6 vs 28.6, P < 0.0001) compared to patients who did not receive IV iron. Multivariable modeling, controlling for blood loss, preoperative hemoglobin, surgical duration, CELL SALVAGE use, complications, myomectomy, and laparotomy, identified IV iron use as independently associated with a reduced likelihood of requiring a postoperative blood transfusion (adjusted odds ratio [aOR] = 0.4317, P = 0.0059). In patients with hemoglobin less than 10.0 g/dL at preoperative assessment, surgery scheduled after implementation of the PPAE program (aOR = 19.41, P < 0.0001) was independently associated with increased rates of IV iron use.

Despite lower baseline hemoglobin values and greater surgical complexity, use of IV iron was independently associated with a reduced risk of blood transfusion. Among patients with moderate-to-severe preoperative anemia, IV iron use was more likely after implementation of a standardized PPAE referral pathway.