The Effect of Intraoperative Ferric Carboxymaltose in Joint Arthroplasty Patients: A Randomized Trial

Park, Hee Sun; Kim, Tae‐Yop; Kim, Ha-Jung; Ro, Young Jin; Jang, Hwa-Young; Koh, Won Uk

doi:10.3390/jcm8101674

Cited by 15 publications

(56 citation statements)

References 28 publications

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“…However, administration of preoperative IV iron is not always feasible, especially in emergency surgery. Infusing iron intraoperatively is more convenient, but data regarding the effectiveness of this approach are inadequate 19 . We thereby conducted a randomised controlled trial to evaluate the effects of intraoperative IV iron on postoperative Hb levels and transfusion requirements in patients undergoing bimaxillary orthognathic surgery.…”

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confidence: 99%

A randomised trial evaluating the effect of intraoperative iron administration

Lee

Kim

Song

et al. 2020

Sci Rep

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Perioperative anaemia increases postoperative morbidity and mortality, and iron deficiency is anaemia’s most common cause in surgical patients. Preoperative intravenous iron increases postoperative haemoglobin; however, data regarding intraoperative intravenous iron’s effectiveness are inadequate. This study examined intraoperative intravenous iron’s effects on postoperative haemoglobin levels in adults. Fifty-seven healthy subjects (aged 19–40 years) scheduled for bimaxillary orthognathic surgery were assigned randomly to the iron (n = 28) or control (n = 29) groups. The iron group received intravenous ferric derisomaltose (1,000 mg) after anaesthetic induction. The control group received an identical volume of intravenous normal saline. The primary outcome was postoperative haemoglobin level. Secondary outcomes included other postoperative haematologic and iron parameters. Laboratory data were obtained preoperatively and at 1 day, 2 weeks, and 4 weeks postoperatively. Haemoglobin was higher in the iron group 2 weeks postoperatively (12.9 g/dL vs. 12.2 g/dL), but the between-group difference was not significant after adjustment for multiple testing. However, the reticulocyte production index was significantly higher in the iron group 2 weeks postoperatively. Intraoperative intravenous iron maintains postoperative haemoglobin values in patients undergoing bimaxillary orthognathic surgery by increasing haematopoietic function and iron bioavailability and therefore appears to be a useful strategy for blood management.

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confidence: 99%

A randomised trial evaluating the effect of intraoperative iron administration

Lee

Kim

Song

et al. 2020

Sci Rep

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“…Among them, two RCTs reported that iron supplementation did not lower transfusion rates, but other five studies reported lowered transfusion rates when compared with those of the control group. Five studies were conducted in patients with anemia (hemoglobin 10 to 13 g/dL or 1-day post-operative hemoglobin < 10 g/dL) [ 25 , 26 , 30 – 32 ]. One study reported that hemoglobin was higher in the iron supplementation group when compared with that of the control group [ 25 ], and four studies reported that iron supplementation was effective in lowering the transfusion rate [ 25 , 30 – 32 ].…”

Section: Resultsmentioning

confidence: 99%

“…Eleven articles were included in the final analysis. Seven randomized controlled trials (RCTs) [22][23][24][25][26][27][28], one prospective cohort study [29], and three retrospective cohort studies [30][31][32] were included for the final analysis. Two of them were studies with conflict of interest [23,32].…”

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confidence: 99%

“…Effectiveness of iron supplementation was evaluated using nine articles that performed case-control comparison (Table 3) [24][25][26][27][28][29][30][31][32]. Among them, five articles used intravenously administered iron supplementation [25,26,[30][31][32], three used orally administered iron supplementation [24,27,28], and one selectively used intravenously or orally administered iron supplementation according to the level of serum ferritin [29]. In each study, the effect of iron supplementation was compared by comparing change in hemoglobin level and transfusion rate after surgery.…”

Section: Effectiveness Of Iron Supplementationmentioning

confidence: 99%

“…Seven studies reported transfusion rate which is shown in Fig. 2 [24][25][26][29][30][31][32]. Figure 2 also include one another study that reported transfusion rates by iron administration method [23].…”

Section: Effectiveness Of Iron Supplementationmentioning

confidence: 99%

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Effectiveness of iron supplementation in the perioperative management of total knee arthroplasty: a systematic review

Lee

Kim

Choi

et al. 2020

Knee Surg & Relat Res

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Introduction/purpose: The purpose of this systematic review was to evaluate the effect of iron supplementation during total knee arthroplasty (TKA): (1) Is the iron supplementation necessary during TKA? (2) When is the optimal timing of iron supplementation? (3) Which is better, between orally and intravenously administered iron supplementation? And (4) What is the optimal dose of iron supplementation? Materials and methods: A rigorous and systematic approach was used and each of the selected studies was evaluated for methodological quality. Data about study design, total number of cases enrolled, iron administration method, timing, and dose were extracted. Change in hemoglobin and transfusion rates were extracted to evaluate the effectiveness of iron supplementation. Results: Eleven studies were included in the final analysis. Most of studies reported that hemoglobin change between iron and control group did not show any difference. Only one study reported that iron supplementation could reduce the decrease in hemoglobin. However, transfusion rate showed a decrease in the iron supplementation group compared with the control group. There was no clear consensus on the optimum timing and dose of iron supplementation and intravenously administered iron was more effective than orally administered iron, especially in anemic patients. Conclusion: Iron supplementation is not clear as a way to raise hemoglobin levels after TKA, but an effective treatment for lowering transfusion rate, especially in patients with anemia. We could not determine the optimal timing and dose of the iron. Intravenously administered iron was similar to, or better than, orally administered iron for improving hemoglobin levels and transfusion rate.

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Risk of Infection Associated With Administration of Intravenous Iron

et al. 2021

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IMPORTANCEIntravenous iron is recommended by many clinical guidelines based largely on its effectiveness in reducing anemia. However, the association with important safety outcomes, such as infection, remains uncertain. OBJECTIVE To examine the risk of infection associated with intravenous iron compared with oral iron or no iron. DATA SOURCES Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized clinical trials (RCTs) from 1966 to January 31, 2021. Ongoing trials were sought from ClinicalTrials.gov, CENTRAL, and the World Health Organization International Clinical Trials Search Registry Platform. STUDY SELECTION Pairs of reviewers identified RCTs that compared intravenous iron with oral iron or no iron across all patient populations, excluding healthy volunteers. Nonrandomized studies published since January 1, 2007, were also included. A total of 312 full-text articles were assessed for eligibility. DATA EXTRACTION AND SYNTHESIS Data extraction and risk of bias assessments were performed according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) and Cochrane recommendations, and the quality of evidence was assessed using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. Two reviewers extracted data independently. A random-effects model was used to synthesize data from RCTs. A narrative synthesis was performed to characterize the reporting of infection. MAIN OUTCOMES AND MEASURESThe primary outcome was risk of infection. Secondary outcomes included mortality, hospital length of stay, and changes in hemoglobin and red blood cell transfusion requirements. Measures of association were reported as risk ratios (RRs) or mean differences.RESULTS A total of 154 RCTs (32 920 participants) were included in the main analysis. Intravenous iron was associated with an increased risk of infection when compared with oral iron or no iron (RR, 1.17; 95% CI, 1.04-1.31; I 2 = 37%; moderate certainty of evidence). Intravenous iron also was associated with an increase in hemoglobin (mean difference, 0.57 g/dL; 95% CI, 0.50-0.64 g/dL; I 2 = 94%) and a reduction in the risk of requiring a red blood cell transfusion (RR, 0.93; 95% CI, 0.76-0.89; I 2 = 15%) when compared with oral iron or no iron. There was no evidence of an effect on mortality or hospital length of stay. (continued) Key Points Question In patients who require treatment with intravenous iron, what is the evidence that this intervention increases the risk of developing a new infection? Findings In this systematic review and meta-analysis of 154 randomized clinical trials that included 32 920 participants, intravenous iron was associated with an increased risk of infection. Meaning The results of this study suggest that, despite broad advocacy in clinical guidelines, intravenous iron may increase the risk of infection, which must be balanced with the potential benefits of treating anemia and reducing blood transfusion requirements.

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The Effect of Intraoperative Ferric Carboxymaltose in Joint Arthroplasty Patients: A Randomized Trial

Cited by 15 publications

References 28 publications

A randomised trial evaluating the effect of intraoperative iron administration

A randomised trial evaluating the effect of intraoperative iron administration

Effectiveness of iron supplementation in the perioperative management of total knee arthroplasty: a systematic review

Risk of Infection Associated With Administration of Intravenous Iron

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