Abstract
Aim
Non-anaemic iron deficiency although identified as a potential area for improving patient outcome in the literature, its effect on patient outcomes post-surgery is an under researched topic, with numerous gaps in the published literature. The aim of this project was to identify the prevalence of non-anaemic iron deficiency, and its effect on patient outcomes in patients undergoing surgery, with a focus on lower limb arthroplasty. Systematically reviewing the evidence on the effectiveness of treatment of non-anaemic iron deficiency and conducting a randomised controlled trial to explore if a measurable impact on patient outcome can be made.
Results
A retrospective cohort analysis performed on 956 non-anaemic iron deficient patients undergoing lower limb arthroplasty, 2214 in the control group, demonstrated a reduction in postoperative haemoglobin 0.96gdl p=0.007 (CI -1.66 to -0.26) day 1 after surgery in the non-anaemic iron deficient population and an increased length of stay (IRR) 1.08 CI 1.03-1.14 p=0.002. A systematic review of the treatment of non-anaemic iron deficiency demonstrated the lack of available evidence, a meta-analysis at day 1 demonstrated no statistical difference p=0.32 (mean 12.63 CI 9.75 to 15.52), however, narrative synthesis suggested treatment improved patients’ haemoglobin postoperatively. A dual arm parallel randomised controlled trial (RCT) involving supplementation with oral Floradix against no intervention was performed. Unfortunately, the early cessation of the trial due to COVID 19 meant the planned statistical analysis was not able to be performed, the results were presented narratively, demonstrating a trend towards supplementation being beneficial, however, due to the early cessation of the trial, this could not be shown to be causative and may have been merely an association.
Conclusion.
Non-anaemic iron deficiency is a real phenomenon with an association of adverse post-operative haemoglobin and length of stay, in patients undergoing lower limb arthroplasty. Although the published literature is sparse, supplementation improves may improve patient outcomes. However, further research is recommended to fully explore the potential impact on treatment of non-anaemic iron deficiency in patients undergoing lower limb arthroplasty and the application to the wider patient population.
