
 Study of the incidence of iron deficiency in abdominal aortic aneurysm surgery
 surgery
 
K.Monthé Sagan, G.Daccache , M.Sesay , Y.Yousfi , M.Boutros , M.Pegoix , L.Berger , JL.Gerard , JL.Hanouz
Introduction :
Iron deficiency is a common cause of preoperative anemia. The perioperative anemia management is a major concern teams of anesthesia and surgery because of its impact on morbidity - patient mortality 1. In major orthopedic surgery, the prevalence or iron deficiency is around 20%. In line with the recommendations of a Health Authority, undergoing major orthopedic surgery, a blood saving policy is applied. It is based, preoperatively, on the prescription of erythropoietin (EPO) and iron at the anesthetic consultation. This strategy has contributed to the decrease of the blood transfusion rate. The use of EPO is frequently forbidden vascular surgery patients, but treatment with iron could be introduced particularly in abdominal aortic surgery (major bleeding risk surgery).The objective of our work was to determine the incidence of iron deficiency in abdominal aortic surgery and its association with perioperative anemia.
Material and methods :
It is an observational, prospective and single-center study.   This study was conducted at the University Hospital of Caen in the vascular surgery department from December 2016 to March 2017. This study was approved by the Comité de Protection des Personnes Nord-Ouest in June 2016. All consecutive patients requiring aortic abdominal surgery was included. A preoperative hemoglobin level of less than 13g / dL defined anemia. A martial assessment was performed the day before the surgery. Iron deficiency was defined as ferritinemia less than 100  g / mL and / or a transferrin saturation factor less than 20% 2 . A monitoring of the hemoglobin level was performed the day before the intervention (D-1) and postoperatively D0, D1 and D3.
Results :
Twenty patients were included. Iron deficiency involved 12 (60%) patients preoperatively. The presence or absence of iron deficiency was our 2 study groups. Populations in each group were comparable in terms of age (74 vs 67, p = 0.13), duration of surgery (176 minutes vs 196 minutes, p = 0.63), vascular filling by crystalloids (1700mL vs. 2000mL, p = 0.52) or colloids (883mL vs1062mL, p = 0.62). The blood recovery by  cellsaver was similar (632mL vs 525mL, p = 0.67). Iron deficiency was not associated with preoperative anemia (p = 0.49). Postoperative anemia on D1 was not associated with iron deficiency (p = 0.62). Postoperatively on D3, all patients had hemoglobin levels below 13g / dL.

Discussion :
The optimization of the treatment depends mainly on the cause of the anemia and the type of surgery. This study shows a high rate of martial deficiency in abdominal aortic surgery. However, this is not associated with preoperative anemia.

Conclusion :
In abdominal aortic surgery, the prevalence of iron deficiency, preoperatively, is high. However, it is not associated with perioperative anemia. This observation does allow better target the causes and treatments of anemia in this context.
 
1.Diehm N, et al. J Vasc Surg . 2007
2.Lasocki S, et al. P E anointed ssential SFAR. 2016
 



 



10 / Study of the incidence of iron deficiency in abdominal aortic aneurysm surgery