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Improved patient blood management and cost saving in hip replacement surgery through the implementation of pre-operative Sucrosomial® iron supplementation: a quality improvement assessment study

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Abstract

Purpose

To compare post-operative recovery of prosthetic hip surgery patients with or without the implementation of iron supplementation with a new highly absorbable oral iron formulation.

Methods

Observational retrospective quality improvement assessment conducted on patients who had undergone elective prosthetic hip surgery (first implant) with ferritin < 100 mcg/dl and Hb values between 13 and 14 g/dl for men and 12 g/dl and 13.5 g/dl for women, or having ferritin levels > 100 mcg/dl but C-reactive protein (CRP) > 3 mg/l and transferrin saturation (TSAT) < 20%, which together are suggestive of functional iron deficiency. The analysis compared a group of non-anaemic patients having ferritin levels > 100 mcg/l to two groups of patients with iron deficiency, of which only one received iron supplementation. Measurements included haemoglobin levels, length of hospital stay, and number of transfused patients/blood units.

Results

Patients with iron deficiency supplemented with Sideral® Forte compared to non-supplemented patients showed a smaller decline in post-operative Hb (9.7 ± 1.24 g/dl vs 8.4 ± 0.6 g/dl), required shorter hospital stay (4 vs 6.5 days) and less blood transfusions (0 in the iron-supplemented group vs 7 units in the non-iron-supplemented group), yielding an overall savings of 1763.25 €/patient.

Conclusions

Pre-operative sucrosomial iron supplementation at least 4 weeks prior to elective surgery in non-anaemic patients limits the drop in post-operative Hb levels, determining higher post-operative haemoglobin, quicker post-surgical recovery, shorter hospitalisation, and decreased surgery-related costs.

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Acknowledgements

The authors are grateful to Manuella Walker for assisting in drafting the manuscript.

Funding source

Financial support for language editing has been provided by PharmaNutra, Pisa, Italy, which has however not taken part in the study design, data collection or analyses, or writing of the paper.

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Authors and Affiliations

  1. Anesthesiology Hip and Knee Replacement Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy

    Marco Scardino, Federica Martorelli & Tiziana D’Amato

  2. Humanitas University Department of Biomedical Sciences, Via Manzoni 113, 20089, Rozzano, MI, Italy

    Berardo Di Matteo & Elizaveta Kon

  3. Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, MI, Italy

    Berardo Di Matteo & Elizaveta Kon

  4. Management and Operation Control Unit, Humanitas Clinical and Research Center TECHINT Group, Rozzano, Milan, Italy

    Dario Tanzi

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  1. Marco Scardino
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Correspondence to Berardo Di Matteo.

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The authors declare that they have no conflict of interest.

Ethical approval

The present study was performed in accordance with the principles outlined in the Declaration of Helsinki. Being an initiative of a pre-operative protocol standardisation established at the Orthopaedics Department, the study was presented to the local Ethics Committee of the Humanitas Research Hospital for approval and patients’ clinical data were handled as agreed by patient’s informed consent.

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Scardino, M., Di Matteo, B., Martorelli, F. et al. Improved patient blood management and cost saving in hip replacement surgery through the implementation of pre-operative Sucrosomial® iron supplementation: a quality improvement assessment study. International Orthopaedics (SICOT) 43, 39–46 (2019). https://doi.org/10.1007/s00264-018-4149-7

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