What is it about?

In Orthopedics, about 17.5% of all subjects undergoing elective hip or knee replacement present iron-deficiency anemia, 20%–30% have uncharacterized anemia, and over 50% may require preoperative blood transfusions, with trauma patients possibly presenting higher rates. Regardless of etiology, anemia conditions are associated with wound complications, readmissions, higher transfusions, and mortality rates. Perioperative blood losses further compromise oxygen supply, thus creating an imbalance for increased demands that reduces cardiac ejection function, increases the risk of ischemia, lengthens skeletal muscles recovery, and impacts on breathing capacity—in turn, worsening the anesthesia-derived hypoventilation. The required allogeneic blood transfusions expose institutions to higher costs, thus making it necessary to develop strategies to mitigate risks. A preoperative intervention to observe the efficacy and tolerability of an oral iron therapy in ameliorating the martial status of patients undergoing hip or knee surgery at IRCCS Orthopedic Institute Galeazzi has been planned. This intervention can be considered one of the very first steps in building the future POC (Preoperative Optimization Clinic).

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Why is it important?

Literature evidences and laws recommendations stress the need to improve martial status before orthopedic surgery and this integration can be exploited in the orthopedic POC. However, no pragmatic connection exists between guideline statements and their effectiveness, and the identification of deficient patients relies on often-hardy applicable algorithms. Managing a nutritional supplementation with iron sources is pertinent for the proper care of orthopedic patients that face important blood losses, with the key factor for success being always the same: a constructive multidisciplinary team capable to bring to light any relevant aspect to guarantee the entire orthopedic population a medicine as precise as possible

Perspectives

We supported a population medicine approach, which has already been proved to be effective even in the most complicated patients, and obtained remarkable results dependent on age, gastrointestinal conditions, and medications. Instead of choosing patients that should or should not undergo oral iron supplementation, future POC may sustain a basic “iron prophylaxis” for all orthopedic patients. The concept of timing is extremely relevant, either within the same day or through alternative days, with important differences in tolerability and absorption. Alternative solutions at the population level might be required in the near future to correct anemia long before surgery. For instance, the American National Heart, Lung, and Blood Institute defines healthy eating changes, and not oral iron supplementation, as first-line treatments for mild to moderate iron-deficiency anemia.

Dr. M. Briguglio
IRCCS Ospedale Galeazzi - Sant'Ambrogio

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This page is a summary of: Oral Supplementation with Sucrosomial Ferric Pyrophosphate Plus L-Ascorbic Acid to Ameliorate the Martial Status: A Randomized Controlled Trial, Nutrients, January 2020, MDPI AG,
DOI: 10.3390/nu12020386.
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