title: Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery.
abstract: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use.
  
  
  
  A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesis-stimulating agents, and erythropoietin.
  
  
  
  All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery patients were evaluated, provided they reported blood transfusion outcomes.
  
  
  
  A total of 9 prospective and retrospective studies and 1 meta-analysis were identified and included. In the preoperative setting, administration of oral iron, IV iron, or ESA alone or in combination to correct underlying anemia led to significantly reduced transfusion rates. Transfusion requirements were generally less with combination therapy (ESA + oral or IV iron). In the short-term perioperative or postoperative period, use of oral or IV iron led to conflicting results, with some reporting a statistically significant reduction in blood transfusions, whereas others reported none.
  
  
  
  In elective orthopedic surgery, IV or oral iron with or without an ESA may provide benefit in prevention of postoperative anemia and results in blood transfusion reduction without significantly increasing the risk of adverse events. These agents should be considered at the lowest effective dose with emphasis on administration prior to planned surgery.
authors.affiliation: Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA Indiana University Health, Methodist Hospital, Indianapolis, IN, USA tsteuber@butler.edu.
authors.forename: Taylor D
authors.initials: TD
authors.lastname: Steuber
authors.affiliation: University of North Texas System College of Pharmacy, Fort Worth, TX, USA.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Howard
authors.affiliation: Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA Indiana University Health, Methodist Hospital, Indianapolis, IN, USA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Nisly
mesh_terms: D061605:Administration, Intravenous; D000740:Anemia / Q000517:prevention & control*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D017558:Elective Surgical Procedures; D004921:Erythropoietin / Q000378:metabolism; D005260:Female; D006397:Hematinics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007501:Iron / Q000627:therapeutic use*; D019637:Orthopedic Procedures; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: C554270:EPO protein, human; D006397:Hematinics; D004921:Erythropoietin; D007501:Iron
keywords: anemia; blood transfusion; elective orthopedic surgery; erythropoiesis-stimulating agent; iron