Key result
Preoperative oral iron is linked to ~5% lower 90-day postoperative morbidity or mortality.
Why the study?
Correction of preoperative iron deficiency is widely recommended, but data on oral iron therapy in this setting are limited.
Does preoperative oral iron supplementation reduce postoperative morbidity or mortality in patients undergoing major surgery?
Cohort (n=947,468)
Yes
Does preoperative oral iron supplementation reduce postoperative morbidity or mortality in patients undergoing major surgery?
Preoperative oral iron supplementation is associated with a modest reduction in 90-day postoperative morbidity and mortality in patients undergoing major surgery.
Answers are grounded in this paper and cite their sources.
Preoperative oral iron was associated with modestly lower POD90 morbidity/mortality; leaves open whether randomized trials will confirm benefit in major surgery.
BACKGROUND: Correction of preoperative iron deficiency (with or without anemia) is widely recommended but data on oral iron therapy in this setting are limited. This study evaluated the impact of preoperative oral iron supplementation on postoperative morbidity and mortality in patients undergoing major surgery. METHODS: Using retrospective data from the French Système National des Données de Santé (SNDS) database, this study included patients who underwent major surgeries (orthopedic, onco-digestive, cardiac, onco-urologic, onco-gynecologic) between January 2017 and September 2019. Postoperative morbidity (re-hospitalization, venous thromboembolism, renal insufficiency, infection, stroke/myocardial infarction, intensive care unit admission) or mortality until postoperative day 90 (POD90) was assessed in patients who received oral iron in the 8 weeks before surgery versus those with no iron supplementation. The probability of postoperative morbidity or mortality was estimated by adjusted logistic regression. RESULTS: In total, 947,468 patients underwent 975,852 surgeries, of whom only 69,377 (7.1%) had received oral iron preoperatively. The incidence of postoperative morbidity or mortality was lower in the "oral iron" versus "no iron" group (20.2% vs. 21.6%; p < 0.001). In the adjusted logistic regression analysis, oral iron was associated with a lower probability of POD90 morbidity or mortality (odds ratio [OR] 0.95; 95% confidence interval [CI] [0.93, 0.97]; p < 0.001) and POD90 mortality (OR 0.85; 95% CI [0.79, 0.92]; p < 0.001) versus no iron. CONCLUSION: In this large, real-world cohort study of patients undergoing major surgery, preoperative oral iron was associated with a lower probability of postoperative morbidity or mortality compared with no iron therapy.
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Lasocki et al. (2025) conducted a cohort in Major surgery (n=947,468). Preoperative oral iron vs. No iron supplementation was evaluated on Postoperative morbidity (re-hospitalization, venous thromboembolism, renal insufficiency, infection, stroke/myocardial infarction, intensive care unit admission) or mortality until postoperative day 90 (OR 0.95, 95% CI 0.93-0.97, p=< 0.001). Preoperative oral iron was associated with a lower probability of 90-day postoperative morbidity or mortality compared with no iron therapy.
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