Medico Economic Evaluation of Oral Iron Supplementation in Major Surgeries: A French Nationwide Healthcare Database Study

OBJECTIVES: This study evaluates the benefits of oral iron supplementation given before major surgeries (in 5 areas) on Postoperative Morbi-Mortality (PMM) and the associated costs.

METHODS: This retrospective study used SNDS data integrating the main French national health database. All patients who underwent major surgeries (orthopedic, oncological-digestive, cardiac, oncological-gynecological, oncological-urological surgeries) between January 2017 and September 2019 were eligible. PMM were defined as re-hospitalization, venous thrombo-embolism (VTE), infection, stroke/myocardial infarction, unplanned admission to ICU, renal insufficiency, and postoperative death occurring within 90 days following surgery (POD90).

Patients were separated in 2 groups, depending on whether they received oral iron within 8 weeks prior to surgery (oral iron group) or not (no iron group). Unadjusted and adjusted, matched, conditional logistic regression models were used to evaluate PMM risk. The associated costs of care were described overall and by type of event.

RESULTS: Of 975,852 included patients, 7.1% received oral iron supplementation within 8 weeks prior to surgery. They had a lower adjusted PMM risk (OR=0.93, 95% CI [0.91–0.95], p<.001 using a matched analysis on anemia risks factors). These was particularly true for VTE occurrence (OR=0.84 [0.80-0.87]), infection (OR=0.93 [0.90-0.97]), ICU admission (OR=90 [0.84-0.96]), and death (OR=0.91 [0.83-0.99] (p<.04).

Length of hospital stay were numerically shorter in oral iron group (7.3±6.0 vs 7.7±6.7 days). Median costs of care associated with PMM were numerically higher in no iron group at POD90 compared to oral iron group for hospitalization for VTE (3796€ vs 3674€), renal failure (7221€ vs 6918€) and stroke (4425.7€ vs 4395.3€).

CONCLUSIONS: In this real-life cohort, oral iron supplementation within 8 weeks before major surgery is associated with less PMM at POD90 than that with no iron supplementation. Oral iron group had also a lower cost of care at POD90. Further analyses are underway to assess the total cost of care depending on the supplementation.