Park Hee-Sun, Bin Seong-Il, Kim Ha-Jung, Kim Tae-Yop, Kim Jiyoung, Kim Hyungtae, Ro Youngjin, Koh Won Uk
Department of Anaesthesiology and Pain Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Vox Sang. 2022 Apr;117(4):562-569. doi: 10.1111/vox.13230. Epub 2021 Dec 12.
Staggered bilateral total knee arthroplasty, two procedures performed 4-7 days apart during a single hospitalization, has an increased risk of blood transfusion. This observational study aimed to evaluate whether immediate post-operative single, high-dose intravenous iron supplementation could reduce transfusion requirements and facilitate anaemia recovery in patients.
We retrospectively analysed 131 patients who underwent staggered bilateral total knee arthroplasty. The ferric carboxymaltose (FCM) group received 1000 mg of FCM after the first operation. The non-FCM group did not receive intravenous iron. The transfusion rate and post-operative complications were compared between the groups. The anaemia rate was evaluated pre-operatively, during hospitalization, and 5 weeks after the second total knee arthroplasty.
The FCM group comprised 78 patients (59.5%). The rate (21.8% vs. 47.2%, p = 0.004) and amount of transfusion (0 [0-2] vs. 0 [0-0], p = 0.001) was significantly lower in the FCM group than in the non-FCM group. Although both groups' pre-operative haemoglobin concentrations were not significantly different, the FCM group demonstrated higher haemoglobin values 5 weeks post surgery (12.25 ± 0.83 mg/dl vs. 11.48 ± 1.36 mg/dl, p < 0.001). More non-FCM patients developed moderate to severe anaemia at 5 weeks post surgery (p < 0.001). The mortality and complication rates were not significantly different.
Immediate post-operative, high-dose, intravenous iron treatment may contribute to reduced transfusion rates, facilitate haemoglobin recovery after staggered bilateral total knee arthroplasty, and minimize the development of moderate to severe anaemia.
分期双侧全膝关节置换术是在单次住院期间分4 - 7天进行的两个手术，输血风险增加。这项观察性研究旨在评估术后立即单次给予高剂量静脉补铁是否能减少患者的输血需求并促进贫血恢复。
我们回顾性分析了131例行分期双侧全膝关节置换术的患者。羧基麦芽糖铁（FCM）组在第一次手术后接受1000mg FCM。非FCM组未接受静脉补铁。比较两组的输血率和术后并发症。在术前、住院期间以及第二次全膝关节置换术后5周评估贫血率。
FCM组包括78例患者（59.5%）。FCM组的输血率（21.8%对47.2%，p = 0.004）和输血量（0[0 - 2]对0[0 - 0]，p = 0.001）显著低于非FCM组。尽管两组术前血红蛋白浓度无显著差异，但FCM组术后5周血红蛋白值更高（12.25±0.83mg/dl对11.48±1.36mg/dl，p < 0.001）。更多非FCM组患者在术后5周出现中度至重度贫血（p < 0.001）。死亡率和并发症发生率无显著差异。
术后立即进行高剂量静脉补铁治疗可能有助于降低输血率，促进分期双侧全膝关节置换术后血红蛋白恢复，并使中度至重度贫血的发生降至最低。
