• Manuel Muñoz, Susana Gómez-Ramírez, Jorge Cuenca, José Antonio García-Erce, Daniel Iglesias-Aparicio, Sami Haman-Alcober, Daniel Ariza, and Enrique Naveira.
• 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.
• Transfusion. 2014 Feb 1; 54 (2): 289-99.

BackgroundPostoperative 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.Study Design And MethodsPooled 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).ResultsCompared 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.ConclusionDespite 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.© 2013 American Association of Blood Banks.

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