Quality statement 1: Iron supplementation

Quality statement

People with iron-deficiency anaemia who are having surgery are offered iron supplementation before and after surgery.

Rationale

Preoperative anaemia is associated with increased postoperative morbidity and mortality, and with increased transfusion needs. Treating iron deficiency with iron supplements can reduce the need for blood transfusion. This avoids serious risks associated with blood transfusion, for example infection, fluid overload and incorrect blood transfusions being given. It may also reduce the length of hospital stays and the cost to the NHS. Depending on the circumstances, the cause of the iron deficiency should be investigated before or after surgery.

Quality measures

Structure

a) Evidence of local arrangements to ensure that people with iron-deficiency anaemia who are having surgery are offered iron supplementation before surgery.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that people with iron-deficiency anaemia are offered iron supplementation after surgery.

Data source: Local data collection.

Process

a) Proportion of people with iron-deficiency anaemia who are having surgery and receive iron supplementation before surgery.

Numerator – the number in the denominator who receive iron supplementation before surgery.

Denominator – the number of people with iron-deficiency anaemia who are having surgery.

Data source: Local data collection.

b) Proportion of people with iron-deficiency anaemia who receive iron supplementation after surgery.

Numerator – the number in the denominator who receive iron supplementation.

Denominator – the number of people with iron-deficiency anaemia who have had surgery.

Data source: Local data collection.

Outcome

Blood transfusion rates associated with surgery.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (primary and secondary care services) ensure that systems are in place to offer iron supplementation before and after surgery to people with iron-deficiency anaemia.

Healthcare professionals (doctors, nurses and blood transfusion specialists) offer iron supplementation before and after surgery to people with iron-deficiency anaemia.

Commissioners (clinical commissioning groups) commission services that offer iron supplementation before and after surgery for people with iron-deficiency anaemia.

People who are having an operation and have anaemia caused by a lack of iron should be offered iron (usually as tablets) before and after the operation.

Source guidance

Definitions of terms used in this quality statement

Iron supplementation

People should have their haemoglobin levels checked at least 2 weeks before surgery, if possible and necessary for the procedure they are having. If they have iron-deficiency anaemia, they should be offered iron supplementation. Oral iron should be offered initially, and started at least 2 weeks before surgery. If oral iron is not appropriate, intravenous iron should be offered.

[NICE's guideline on blood transfusion (recommendations 1.1.2 and 1.1.3) and expert consensus]