Effect of preoperative oral iron on postoperative morbidity or mortality after major surgery: A French nationwide healthcare database study

Anaesth Crit Care Pain Med. 2025 Nov 20:101705. doi: 10.1016/j.accpm.2025.101705. Online ahead of print.

ABSTRACT

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 FrenchSystème 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.

PMID:41274379 | DOI:10.1016/j.accpm.2025.101705