Is there a role for perioperative intravenous iron therapy in orthopedic and trauma surgery? Clinical experience in major lower limb surgery

Abstract

SUMMARYPerioperative anemia is a common condition among orthopedic and trauma surgery patients. Preoperative anemia is most frequently caused by iron deficiency or chronic inflammatory disease and is one of the major predictive factors for perioperative blood transfusion. In addition to preoperative anemia, perioperative blood loss is a major cause of postoperative anemia although blunted erythropoiesis attributable to inflammation‐induced inhibition of erythropoietin (EPO) action and decreased iron availability may also play a role. We assessed the safety and effectiveness of perioperative intravenous iron administration, with or without EPO, to stimulate erythropoiesis in patients undergoing trauma (hip fracture) or elective orthopedic surgery (knee and hip replacement). Overall, no side effects were observed. The treatment resulted in lower transfusion requirements, decreased postoperative infection and mortality rates, and shorter length of hospital stay. If confirmed by large randomized clinical trials, these findings will provide a rationale to treat orthopedic and trauma patients with intravenous iron, alone or in combination with EPO, in order to attain higher postoperative hemoglobin concentrations, reduce postoperative complications and shorten hospital stay while limiting exposure to allogeneic blood.