Assessment of Postoperative Complications Following Preoperative Iron Administration in Patients with Low Hemoglobin

Introduction: Patients with anemia and lower preoperative hemoglobin comprise an elevated-risk patient population that may require preoperative optimization to reduce surgical complications. Enhanced recovery after surgery (ERAS) is a specialized program aimed at high-risk patient populations with the goal of preoperative, perioperative, and postoperative optimization to minimize complications. Specific policies for these patients suggest preoperative iron administration to enhance recovery. This study seeks to assess if iron dosing before surgery enhances complication risk.

Methods: Patient cohorts included the first surgery in patients who received single or greater-level posterior lumbar fusions between 2017-2024. Patient inclusion required a 90-day preoperative hemoglobin of < 11. Data on operative transfusions, iron or EPO administration, and postoperative complications were collected. Comparisons were accomplished using chi-square, student's t-test, and regression analysis.

Results: From 2017 to 2024, 347 patients were included. 211 (60.1%) of patients were female, the average age was 64.8 ± 14.6 ¬, and 210 (72.4%) were diagnosed with anemia at the time of surgery. 57 patients received iron dextran, ferrous sulfate, or epoetin alfa up to 90 days before surgery. 95 patients required at least 1 unit of blood during their admission and there were no differences between those with and without iron pre-treatment (p = 0.925). In general, complication rates were not different between the two groups. Importantly, there were no differences between post-procedural cardiovascular complications (p = 0.097) or length of stay (p=0.127). Logistic regression adjusting for iron administration, diabetes, hypertension, surgery type, age, anemia diagnosis, and average hemoglobin, highlighted anemia diagnosis (OR: 1.16 (1.04-1.3)) as the only predictor of blood transfusion requirement.

Conclusion : Preoperative optimization of high-risk patients is an important risk-mitigation strategy to decrease peri-operative and post-operative complications. Patients with low hemoglobin before surgery did not demonstrate differences in blood transfusion requirements or other cardiovascular complications with preoperative iron dosing.