title: Very-short-term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients.
abstract: BACKGROUND
  Postoperative nosocomial infection (PNI) is a severe complication in surgical patients. Known risk factors of PNI such as allogeneic blood transfusions (ABTs), anemia, and iron deficiency are manageable with perioperative intravenous (IV) iron therapy. To address potential concerns about IV iron and the risk of PNI, we studied a large series of orthopedic surgical patients for possible relations between IV iron, ABT, and PNI.
  
  
  METHODS
  Pooled data on ABT, PNI, 30-day mortality, and length of hospital stay (LHS) from 2547 patients undergoing elective lower-limb arthroplasty (n = 1186) or hip fracture repair (n = 1361) were compared between patients who received either very-short-term perioperative IV iron (200-600 mg; n = 1538), with or without recombinant human erythropoietin (rHuEPO; 40,000 IU), or standard treatment (n = 1009).
  
  
  RESULTS
  Compared to standard therapy, perioperative IV iron reduced rates of ABT (32.4% vs. 48.8%; p = 0.001), PNI (10.7% vs. 26.9%; p = 0.001), and 30-day mortality (4.8% vs. 9.4%; p = 0.003) and the LHS (11.9 days vs. 13.4 days; p = 0.001) in hip fracture patients. These benefits were observed in both transfused and nontransfused patients. Also in elective arthroplasty, IV iron reduced ABT rates (8.9% vs. 30.1%; p = 0.001) and LHS (8.4 days vs.10.7 days; p = 0.001), without differences in PNI rates (2.8% vs. 3.7%; p = 0.417), and there was no 30-day mortality.
  
  
  CONCLUSIONS
  Despite known limitations of pooled observational analyses, these results suggest that very-short-term perioperative administration of IV iron, with or without rHuEPO, in major lower limb orthopedic procedures is associated with reduced ABT rates and LHS, without increasing postoperative morbidity or mortality.
authors.affiliation: Transfusion Medicine, School of Medicine, University of Málaga; Internal Medicine and Anesthesiology, U.H.Virgen de la Victoria, Málaga, Spain; Orthopedic Surgery, U.H. Miguel Servet, Zaragoza, Spain; Hematology and Hemotherapy, G.H. San Jorge, Huesca, Spain; Postoperative Care Unit, H. Santa Elena, Torremolinos, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Muñoz
authors.forename: Susana
authors.initials: S
authors.lastname: Gómez-Ramírez
authors.forename: Jorge
authors.initials: J
authors.lastname: Cuenca
authors.forename: José Antonio
authors.initials: JA
authors.lastname: García-Erce
authors.forename: Daniel
authors.initials: D
authors.lastname: Iglesias-Aparicio
authors.forename: Sami
authors.initials: S
authors.lastname: Haman-Alcober
authors.forename: Daniel
authors.initials: D
authors.lastname: Ariza
authors.forename: Enrique
authors.initials: E
authors.lastname: Naveira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000401:mortality*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000401:mortality* / Q000517:prevention & control; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D006397:Hematinics / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D007501:Iron / Q000008:administration & dosage*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D064887:Observational Studies as Topic; D019637:Orthopedic Procedures / Q000401:mortality*; D059035:Perioperative Period / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction
chemical_list: D006397:Hematinics; D004921:Erythropoietin; D007501:Iron