Iron oral supplementation in anemic patients undergoing orthopedic prosthetic surgery: a randomised trial comparing short_term and prolonged administration regimen

Abstract

Preoperative anaemia in patients undergoing major elective orthopaedic surgery is a relatively frequent condition and is associated with perioperative transfusions. The aim of the present study was to investigate the efficacy of liposomal iron, folic acid, and vitamins in reducing the transfusion rate in anaemic patients undergoing major orthopaedic surgery comparing two different administration regimens. One hundred twenty-nine consecutive anaemic patients (haemoglobin level < 13 g/dL in males and < 12 g/dL in females and/or transferrin saturation ≤ 10%) undergoing primary unilateral total hip or knee replacement received liposomal iron, folic acid and vitamins prior to surgery were randomized to receive treatment lasting 15 days (short-duration supplementation group, SS group) or 30 days (long-duration supplementation group, SS group). Complete blood count and transferrin tests were collected upon admission and on the 1st, 3rd, and 7th postoperative days. Patients were 74 ± 9.1 years old on average, and 96 (74%) were female. Treatment was started 47 ± 32.0 days before surgery. Overall transfusion rate was 8.5% (11/129) with no significant difference ( p = 0.163) between the SS group (3/67 = 4.5%) and the LS group (8/62 = 12.9%). Overall decrease in haemoglobin between admission and 7th postoperative day was 2.6 (SD, 1.0) g/dL, with no statistically significant differences between SS and LS group (2.7 g/dL; SD, 1.0; and 2.4 g/dL SD:1.1, respectively; p = 0.111). The transfusion rate did not significantly differ between patients undergoing hip and knee surgery, being 8.5% in both groups ( p = 0.605). Patients initiating treatment 30 to 44 days before surgery showed a smaller drop in postoperative haemoglobin, although not statistically significant ( p = 0.383). Within a multimodal PBM protocol, the overall transfusion rate for anaemic patients undergoing elective joint replacement surgery was low. Prolonged supplementation was not superior to short-duration supplementation, although the relatively small sample size may have precluded establishing a significant intergroup difference. These findings can help reduce costs and improve compliance when preparing anaemic patients for surgical interventions. The trial was registered on Clinicaltrials.gov (ID NCT05806437) on March 28th 2023.