From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
J Am Acad Orthop Surg. 2021 Dec 1;29(23):e1200-e1207. doi: 10.5435/JAAOS-D-20-01171.
Postoperative anemia is associated with substantial morbidity and mortality in total joint arthroplasty (TJA). Our primary objective was to determine whether perioperative iron supplementation improves postoperative hemoglobin levels in TJA. Secondary objectives were to determine the effects of perioperative iron on adverse events, quality of life, and functional measures in TJA.
We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using six databases. We included English-language, randomized controlled trials investigating intraoperative or postoperative iron supplementation in elective TJA that reported postoperative hemoglobin levels in patients aged 18 years or older. Seven eligible studies were identified, among which substantial heterogeneity was noted. Bias risk was low in four studies, unclear in two studies, and high in one study. Three studies assessed oral iron supplementation, three assessed intravenous iron supplementation, and one compared oral and intravenous iron supplementation. All intravenous iron was administered intraoperatively, except in the oral versus intravenous comparison.
Postoperative oral iron supplementation had no effect on postoperative hemoglobin levels. Intraoperative and postoperative intravenous iron supplementation was associated with higher postoperative hemoglobin levels and greater increases in hemoglobin levels. Two studies reported rates of anemia and found that intraoperative and postoperative intravenous iron supplementation reduced rates of postoperative anemia at postoperative day 30. No adverse events were associated with iron supplementation. One study found that intravenous iron improved quality of life in TJA patients with severe postoperative anemia compared with those treated with oral iron. Perioperative iron had no effects on functional outcomes.
We found no evidence that postoperative oral iron supplementation improves hemoglobin levels, quality of life, or functional outcomes in elective TJA patients. However, intraoperative and postoperative intravenous iron supplementation may accelerate recovery of hemoglobin levels in these patients.
Level I, systematic review of randomized controlled trials.
全膝关节置换术（TJA）后贫血与大量发病率和死亡率相关。我们的主要目的是确定围手术期铁补充是否能提高 TJA 术后血红蛋白水平。次要目标是确定围手术期铁对 TJA 不良事件、生活质量和功能测量的影响。
我们按照系统评价和荟萃分析的首选报告项目指南进行了系统评价，使用了六个数据库。我们纳入了研究择期 TJA 中术中或术后铁补充对 18 岁或以上患者术后血红蛋白水平影响的英语随机对照试验。确定了 7 项符合条件的研究，其中注意到存在很大的异质性。四项研究的偏倚风险较低，两项研究的偏倚风险不清楚，一项研究的偏倚风险较高。三项研究评估了口服铁补充，三项研究评估了静脉内铁补充，一项研究比较了口服和静脉内铁补充。所有静脉内铁都是在手术中给予的，除了口服与静脉内比较。
术后口服铁补充对术后血红蛋白水平没有影响。术中及术后静脉内铁补充与较高的术后血红蛋白水平和更大的血红蛋白水平增加相关。两项研究报告了贫血发生率，发现术中及术后静脉内铁补充降低了术后 30 天的术后贫血发生率。铁补充没有不良反应。一项研究发现，与口服铁治疗相比，静脉内铁补充可改善严重术后贫血 TJA 患者的生活质量。围手术期铁对功能结果没有影响。
我们没有发现术后口服铁补充能提高择期 TJA 患者的血红蛋白水平、生活质量或功能结果的证据。然而，术中及术后静脉内铁补充可能会加速这些患者血红蛋白水平的恢复。
一级，随机对照试验的系统评价。
