Low peri-operative hemoglobin (Hb) values in orthopedic surgery patients are associated to a longer hospital stay, higher red blood cells transfusion (RBCT) rates and mortality. Compared to non-anaemic patients, anaemic patients have a 42% higher risk of mortality and a 35% higher risk of serious complications [1]. Timely prevention of peri-operative anemia and iron stores can improve patient outcome and reduce RBCT requirements, since pre-operative anaemia appears to be also related to poor prognosis. Sucrosomial® iron (Sideral® Forte, PharmaNutra) is a formulation where iron is covered by phospholipids plus sucrose esters of fatty acids matrix, allowing a higher absorption of iron compared to ferrous sulfate and avoiding typical gastrointestinal side effects. Sucrosomial® iron appears to have high tolerability and to be effective in improving the patient's anaemic condition in terms of serum iron, Hb and ferritin, which have been confirmed by several studies, even in comparison with IV iron treatment, showing similar results [2, 3, 4, 5]. Thus, for these reasons, the efficacy of sucrosomial® iron supplementation in prosthetic hip surgery patients was assessed in terms of Hb levels, length of hospital stay (LOS) and RBCT.

The study was conducted between 2015 and February 2017 on patients undergoing prosthetic hip surgery. The period taken into consideration was a follow-up period after the implementation of the pre-operative protocol, which was gradually implemented from 2011 to 2014 with the introduction of sucrosomial® iron. The protocol includes a full blood count, including CRP and ferritin, 21-28 days prior to surgery during the pre-operative visit. In case of a ferritin level <100 mcg/L and/or Hb level <14 g/dL for male and 13 g/dL for female, sucrosomial® iron is prescribed at a dosage of 1 cps/day corresponding to 30mg of elemental iron, for 21-28 days before and 7-10 days after surgery.

Between 2015 and January 2017, 5869 patients were evaluated, of these 551 patients were anemic and 1958 were iron deficient. Thus, these patients received iron supplementation with an adherence to the treatment of 87%. Since the introduction of Sucrosomial® iron supplementation there was a reduction in the RBCT rate of 67% and the amount of RBCT significantly decreased from 10% in 2015 to 0% units in 2017 in the population treated. Moreover, sucrosomial® iron led to a reduced in the LOS from an average of 15.19 days in 2014 and to an average of 10.36 days in 2017 (Figure 1), which can be associated to a faster Hb recovery after surgery. Indeed, in January 2017 median Hb level at discharge was 11.2 g/dL, 1.3 g/dL higher than in 2014. The estimated saving for the shorter LOS was calculated as 2000 euro/patient, plus additional saving gained from a more efficient use of hospital beds (Figure 1) in addition to the saving derived from a reduced use of RBCT allowing a better allocation of hospital resources. Indeed, it was estimated an overall saving of 385,000 euro for the period taken into consideration.

Pre-operative sucrosomial® iron supplementation 3\4 weeks prior to prosthetic hip surgery patients contained the fall in post-operative Hb levels and determined a faster recovery of Hb levels and functional recovery after surgery, corresponding to a shorter LOS and decreased surgery-related costs.

Bibliography

1. Musallam KM, et al. Lancet (London, England). 2011;378:1396-407.

2. Capra AP, et al. Hematology. 2017:1-6.

3. Mafodda A, et al. Supportive care in cancer. 2017.

4. Parisi F, et al. The Journal of Maternal-Fetal & Neonatal Medicine. 2016:1-21.

5. Pisani A, et al. NDT Journal 2015;30:645-52.

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Disclosures

Pera: Pharmanutra S.p.A.: Employment. Tarantino: Pharmanutra S.p.A.: Employment.

Topics:
iron, cost effectiveness, surgical procedures, operative, anemia, hip joint prosthesis, ferritin, adverse effects, beds, cancer, c-reactive protein

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2017 by The American Society of Hematology
2017
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