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

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...

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Bibliographic Details
Published in:Vox sanguinis 2019-01, Vol.114 (1), p.3-16
Main Authors: Gómez‐Ramírez, Susana, Maldonado‐Ruiz, María Ángeles, Campos‐Garrigues, Arturo, Herrera, Antonio, Muñoz, Manuel
Format: Article
Language:English
Subjects:
Administration, Oral
Anemia
Anemia - drug therapy
Anemia - prevention & control
Bone surgery
Clinical trials
Data analysis
Data processing
Dietary supplements
Erythropoietin
Hemoglobin
Hip
Humans
Infusions, Intravenous
Intravenous administration
intravenous iron
Iron
Iron - administration & dosage
Iron - adverse effects
Iron - therapeutic use
Iron deficiency
Literature reviews
Nutrient deficiency
Observational Studies as Topic
oral iron
Orthopedics
Orthopedics - methods
patient blood management
Patients
Postoperative Complications - drug therapy
Postoperative Complications - prevention & control
Randomization
Randomized Controlled Trials as Topic
recombinant erythropoietin
Side effects
Surgery
Transfusion
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Summary: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 (
ISSN:0042-9007
1423-0410
DOI:10.1111/vox.12718