TY - JOUR
T1 - Association of non-anaemic iron deficiency with postoperative outcomes after fast-track hip and knee arthroplasty
T2 - a prospective cohort study
AU - Jørgensen, Christoffer C
AU - Lindberg-Larsen, Martin
AU - Gromov, Kirill
AU - Varnum, Claus
AU - Bider, Manuel J
AU - Overgaard, Søren
AU - Rathsach Andersen, Mikkel
AU - Hansen, Toben B
AU - Kehlet, Henrik
N1 - Copyright © 2025 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
PY - 2025/8
Y1 - 2025/8
N2 - BACKGROUND: Preoperative iron deficiency anaemia is a common risk factor for worse postoperative outcomes. However, the influence of preoperative iron deficiency without anaemia on postoperative outcomes after hip and knee arthroplasty is uncertain.METHODS: We used the Fast-track Center for Hip and Knee Replacement Database registry from eight Danish departments for this prospective cohort study. Anaemia and iron deficiency were defined as haemoglobin of <130 g L-1 and transferrin saturation <20%, respectively. Patient characteristics were collected using patient-reported questionnaires and information on prescribed medication, laboratory results and follow-up using electronic healthcare records. Quantile regression was used to analyse changes in median days alive and at home at postoperative day 30 (DAH30) and day 90 (DAH90), adjusting for procedure, hospital, and comorbidity. Additional endpoints included length of hospital stay >2 days, 30-day readmission rate, and self-evaluated health (EuroQol Visual Analogue Scale [EQ-VAS]) at 90 days.RESULTS: The cohort included 964 iron deficient and 3919 iron replete participants undergoing primary unilateral hip or knee arthroplasty. Median DAH30 was 29.0 (interquartile range 29.0-30.0) days in both groups, but differently distributed (P<0.001). Adjusted difference in median DAH was -0.00 (95% confidence interval -0.00 to -0.00; P=0.001) and -0.00 (95% confidence interval -0.00 to -0.00; P=0.006) days for DAH30 and DAH90, respectively. There was no association between iron deficiency and any of the other endpoints.CONCLUSIONS: The influence of iron deficiency on days alive and at home at 30 and 90 days after fast-track hip or knee arthroplasty was statistically significant, but of minimal clinical importance. Correction of preoperative iron deficiency without anaemia is unlikely to improve common postoperative outcomes in these procedures.CLINICAL TRIAL REGISTRATION: NCT05613439.
AB - BACKGROUND: Preoperative iron deficiency anaemia is a common risk factor for worse postoperative outcomes. However, the influence of preoperative iron deficiency without anaemia on postoperative outcomes after hip and knee arthroplasty is uncertain.METHODS: We used the Fast-track Center for Hip and Knee Replacement Database registry from eight Danish departments for this prospective cohort study. Anaemia and iron deficiency were defined as haemoglobin of <130 g L-1 and transferrin saturation <20%, respectively. Patient characteristics were collected using patient-reported questionnaires and information on prescribed medication, laboratory results and follow-up using electronic healthcare records. Quantile regression was used to analyse changes in median days alive and at home at postoperative day 30 (DAH30) and day 90 (DAH90), adjusting for procedure, hospital, and comorbidity. Additional endpoints included length of hospital stay >2 days, 30-day readmission rate, and self-evaluated health (EuroQol Visual Analogue Scale [EQ-VAS]) at 90 days.RESULTS: The cohort included 964 iron deficient and 3919 iron replete participants undergoing primary unilateral hip or knee arthroplasty. Median DAH30 was 29.0 (interquartile range 29.0-30.0) days in both groups, but differently distributed (P<0.001). Adjusted difference in median DAH was -0.00 (95% confidence interval -0.00 to -0.00; P=0.001) and -0.00 (95% confidence interval -0.00 to -0.00; P=0.006) days for DAH30 and DAH90, respectively. There was no association between iron deficiency and any of the other endpoints.CONCLUSIONS: The influence of iron deficiency on days alive and at home at 30 and 90 days after fast-track hip or knee arthroplasty was statistically significant, but of minimal clinical importance. Correction of preoperative iron deficiency without anaemia is unlikely to improve common postoperative outcomes in these procedures.CLINICAL TRIAL REGISTRATION: NCT05613439.
KW - Aged
KW - Aged, 80 and over
KW - Anemia, Iron-Deficiency/complications
KW - Arthroplasty, Replacement, Hip/adverse effects
KW - Arthroplasty, Replacement, Knee/adverse effects
KW - Cohort Studies
KW - Denmark/epidemiology
KW - Female
KW - Humans
KW - Iron Deficiencies
KW - Length of Stay/statistics & numerical data
KW - Male
KW - Middle Aged
KW - Patient Readmission/statistics & numerical data
KW - Postoperative Complications/epidemiology
KW - Prospective Studies
KW - Treatment Outcome
KW - Knee arthroplasty
KW - Hip arthroplasty
KW - Iron deficiency
KW - Perioperative medicine
KW - Eras
KW - Orthopaedic surgery
U2 - 10.1016/j.bja.2025.03.039
DO - 10.1016/j.bja.2025.03.039
M3 - Article
C2 - 40404500
SN - 0007-0912
VL - 135
SP - 322
EP - 330
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 2
ER -