Short‐term perioperative iron in major orthopedic surgery: state of the art

Abstract

In major orthopaedic surgery, it is recommended to detect and correct preoperative anaemia several weeks prior to surgery. However, in many cases, the procedure is urgent or the patient is evaluated shortly before the intervention. As iron deficiency is the leading cause of perioperative anaemia, an exhaustive review of the literature was performed to assess the efficacy and safety of short‐term perioperative intravenous, with or without erythropoietin, or postoperative oral or intravenous supplementation in major orthopaedic surgery. Overall, 20 studies met the inclusion criteria. There were 13 randomized trials (moderate quality) and seven observational studies (low to very low quality). The primary outcomes were reduction in transfusion requirements, haemoglobin increase and medication side‐effects during the study period. Data analysis showed that postoperative oral iron administration neither increased haemoglobin nor reduced transfusion requirements, and it was associated with significant gastrointestinal adverse effects (15%). In contrast, for some patient populations, perioperative or postoperative administration of intravenous iron, with or without recombinant erythropoietin, may reduce transfusion requirements and/or hasten the recovery from postoperative, with few clinically relevant adverse effects (<2%). However, discrepancies between randomized trials and observational studies on the possible beneficial effects of short‐term perioperative intravenous iron administration were found for patients undergoing surgery for hip fracture repair. Further studies are needed to elucidate when the treatment should be started, which combination of drugs should be used, and which patient groups would be most benefit.

Association of iron supplementation with risk of transfusion, hospital length of stay, and mortality in geriatric patients undergoing hip fracture surgeries: a meta-analysis

“…The results from the included analyses showed no significant difference among patients who received high doses of iron intravenously (≥ 1000 mg) in any of the above outcomes. This is inconsistent with the results of the currently published studies and guidelines [30]. The reason may be related to the limited studies and small sample size included.…”

Patient blood management during the COVID–19 pandemic: a narrative review

“…The beneficial effects of very short-term treatment with i.v. iron and epoetin alpha have also been observed in elective and non-elective orthopaedic surgery [25]. Intravenous iron is also effective for treating postoperative anaemia, and should be considered, even in cancer patients who are undergoing surgery during the COVID-19 crisis [26,31,32].…”

Incidence of Iron Deficiency and the Role of Intravenous Iron Use in Perioperative Periods

“…Intravenous iron agents have showed their usefulness in orthopedic surgery, and have become “a state of the art”, as described by Muñoz et al These are used on a daily basis in patients at risk for perioperative anemia, decreasing the need for blood transfusion and the number of transfused units, by rapidly correction the hemoglobin concentration. The postoperative recovery is hastened, the length of stay is reduced, and the cost-effectiveness is significant [ 33 , 34 , 35 ].…”