Post-Operative Intravenous Iron Sucrose Versus Post-Operative Oral Iron to Treat Post-Bariatric Abdominoplasty Anaemia (ISAPA): A Prospective, Open-Label, Randomised Controlled Trial

Background: Anaemia and iron deficiency are common following post-bariatric abdominoplasty¹. Given the low oral absorbability of iron resulting from bariatric surgery, it has been hypothesised that post-operative intravenous iron supplementation could be used to treat anaemia in these patients².

 

Methods: In this randomised trial, 56 adult women undergoing post-bariatric abdominoplasty were allocated for post-operative supplementation with 2 intravenous applications of 200 mg of iron saccharate or 100 mg of iron polymaltose complex orally, twice a day for 8 weeks. The primary outcome was the difference in mean haemoglobin levels between groups at post-operative week 8. Secondary outcomes evaluated at post-operative weeks 1, 4 and 8 included iron profile, reticulocyte count, quality of life (SF-36 and FACIT–Fatigue), adverse effects and complications.

 

Findings: The mean baseline haemoglobin levels were 12.71 g/dL (SD 1.06) in the orall group and 12.24 g/dL (SD 1.09) in the intravenous (iv) group, with a drop at post-operative week 8 to 12.54 g/dL (SD 1.18) in the oral group and an increase to 12.80 g/dL (SD 0.81) in the iv group (p = 0.009). The oral group had a haemoglobin deficit of 0.14 g/dL (SD 0.76), whereas the intravenous group had a gain of 0.57 g/dL (SD 0.87; p = 0.002). Iron deficiency was higher in the oral group (81.5%) than in the iv group (40.7%; p = 0.002). There were no differences in reticulocyte counts, quality of life or complications. The intravenous group had no adverse effects, whereas the oral had constipation (17.9%) and diarrhoea (10.7%).

 

Interpretation: Post-operative intravenous administration of iron promoted higher haemoglobin levels and less iron deficiency.

Peri-operative anemia is an independent risk factor for comorbidities and mortality. Although blood transfusion is a traditional treatment for anemia, this intervention is associated with increased morbidity and mortality³. For these reasons, procedures aimed at better utilisation of the patient's own blood, rather than donor blood, termed "patient blood management", have now been recommended⁴. Post-operative intravenous iron supplementation meets this paradigm shift. The results of this trial may imply changes in the guidelines addressing the treatment of patients undergoing post-bariatric plastic surgeries, including the recommendation of intravenous iron administration for a more effective recovery of haemoglobin levels and iron stores, especially important outcomes for post-bariatric patients who will undergo a second surgery in a short period of time⁵.

 

References

1. Montano-Pedroso JC, Garcia EB, Omonte IRV, Rocha MGC, Ferreira LM. Hematological variables and iron status in abdominoplasty after bariatric surgery. Obes Surg. 2013;23(1):7-16.
2. Montano-Pedroso JC, Garcia EB, Novo NF, Veiga DF, Ferreira LM. Postoperative intravenously administered iron sucrose versus postoperative orally administered iron to treat post-bariatric abdominoplasty anaemia (ISAPA): The study protocol for a randomised controlled trial. Trials. 2016;17(1):1-11.
3. Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med. 2008;36(9):2667-2674.
4. Goodnough Lawrence Tim MD, Shander Aryeh MD. Patient Blood Management. Anesthesiology. 2012;116(6):1367-1376.
5. Shermak M a. Pearls and perils of caring for the postbariatric body contouring patient. Plast Reconstr Surg. 2012;130(4):586e-597e.