CPC-113 Preoperative Oral Iron Prescription in the Prevention of Postoperative Acute Anaemia in Orthopaedic Surgery

• Published in: European journal of hospital pharmacy. Science and practice Vol. 20; no. Suppl 1; p. A205
• Main Authors: Razurel, A, Chauny, JV, Politis, B, Dupont, X, Boyeldieu, D, Benhamou, F, Le Mercier, F, Hardy, P
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.03.2013
• Subjects: Anemia; Hemoglobin; Iron; Length of stay; Orthopedics; Surgery
• DOI: 10.1136/ejhpharm-2013-000276.570
• ISSN: 2047-9956

Background A previous study on postoperative acute anaemia in orthopaedic surgery was conducted in 2011 (S1), showing that anaemia is recurrent and not always treated. We have recommended prescribing oral iron in the month preceding surgery. A pre-dispensed oral iron prescription has been set up for use during preoperative anaesthesia consultations. We decided to evaluate the impact of this recommendation by a second study in 2012 (S2). Purpose To assess the impact of preoperative oral iron prescription on the prevalence and treatment of postoperative acute anaemia in orthopaedic surgery. Materials and Methods Both studies included patients who underwent total hip or knee arthroplasty (THA/TKA). S1 was conducted retrospectively on all patients operated on in 2011. S2 was conducted prospectively on patients who had been prescribed preoperative iron in September/October 2012. We collected data about operations, iron prescriptions, haemoglobin levels, transfusions and lengths of stay. ResultsOperations: 327 (S1): 205THA/122TKA vs. 30 (S2): 13THA/17TKA. Postoperative iron prescription: 69% of patients (S1): oral iron 32%, intravenous iron 20%, both oral and intravenous iron 17% vs. 43% of patients (S2): oral iron 23%, intravenous iron 13%, both oral and intravenous iron 7%. Haemoglobin levels: between preoperative and immediate postoperative periods, mean decrease was from 12.9 ± 0.2 g/dl to 11.1 ± 0.1 g/dl (S1) vs. 13.3 ± 0.2 g/dl to 11.7 ± 0.2 g/dl (S2), between preoperative period and hospital discharge, mean loss was 2.2 ± 0.2 g/dl (S1) vs. 1.9 ± 0.17 g/dl (S2) (p < 10–3). Transfusions: 29% of patients (S1) vs. 20% (S2) (p < 10–3). Length of stay: mean was 10.6 ± 0.8 days (S1) vs. 8.3 ± 0.3 days (S2) (p < 0.005). Conclusions The prospective study showed that oral iron preventive treatment significantly decreases haemoglobin level fall, transfusion rate and length of stay. Therefore it is necessary to sensitise prescribers concerning preventive iron coverage. A further study is needed to evaluate the impact of a longer iron preventive treatment on a larger number of patients. No conflict of interest.