{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T16:37:17Z","timestamp":1784047037511,"version":"3.55.0"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T00:00:00Z","timestamp":1718928000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T00:00:00Z","timestamp":1718928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009708","name":"the Novo Nordisk Foundation","doi-asserted-by":"crossref","award":["NNF21SA0073760"],"award-info":[{"award-number":["NNF21SA0073760"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100009708","name":"the Novo Nordisk Foundation","doi-asserted-by":"crossref","award":["NNF21SA0073760"],"award-info":[{"award-number":["NNF21SA0073760"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001734","name":"Copenhagen University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001734","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Perioper Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background and purpose<\/jats:title>\n                <jats:p>Preoperative anaemia including iron deficiency anaemia (IDA) is a well-established perioperative risk factor. However, most studies on iron therapy to treat IDA have been negative and few have been conducted within an enhanced recovery after surgery (ERAS) protocol. Furthermore, patients with IDA often have comorbidities not necessarily influenced by iron, but potentially influencing traditional study endpoints such as length of stay (LOS), morbidity, etc. The aim of this paper is to discuss patient-related challenges when planning outcome studies on the potential benefits of iron therapy in patients with IDA, based upon a large detailed prospective database in ERAS total hip (THA) and knee arthroplasty (TKA).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A prospective observational cohort study in ERAS THA and TKA from 2022 to 2023. Detailed complete follow-up through questionnaires and electronic medical records.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 3655 included patients, 276 (7.6%) had IDA defined as a haemoglobin (Hb) of\u2009&lt;\u200913.0\u00a0g\/dL and transferrin saturation of 0.20, while 3379 had a Hb of\u2009\u2265\u200913.0. Patients with IDA were a median 5\u00a0years older than non-anaemics, with an increased fraction living alone (38.4% vs. 28.8%), using walking aids (54.3% vs 26.4%) and receiving home care (16.2% vs 4.7%). Fewer IDA patients were working (12.7% vs. 29.6%) and a median number of prescribed drugs was higher (10 vs. 6).<\/jats:p>\n                <jats:p>Median LOS was 1\u00a0day in both IDA and non-anaemic patients, but a LOS of\u2009&gt;\u20092\u00a0days occurred in 11.6% of patients with IDA vs. 4.3% in non-anaemics. The proportion with 30- or 90-day readmissions was 6.5% vs. 4.1% and. 13.4% vs6.0%, in patients with IDA and non-anaemics, respectively. However, potentially anaemia or iron deficiency-related causes of LOS\u2009&gt;\u20092\u00a0days or 90-day readmissions were only 5.4% and 2.2% in patients with IDA and 1.9% and 1.0% in non-anaemics.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Conventional randomised trials with single or composite \u201chard\u201d endpoints are at risk of being inconclusive or underpowered due to a considerable burden of other patient-related risk factors and with postoperative complications which may not be modifiable by correction of IDA per se. We will propose to gain further insights from detailed observational and mechanistic studies prior to initiating extensive randomised studies.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13741-024-00426-3","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T13:02:15Z","timestamp":1718974935000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Outcome improvement for anaemia and iron deficiency in ERAS hip and knee arthroplasty: a descriptive analysis"],"prefix":"10.1186","volume":"13","author":[{"given":"Christoffer Calov","family":"J\u00f8rgensen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Kehlet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The Center for Fast-track Hip, Knee Replacement Collaborative Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torben B.","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirill","family":"Gromov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Jakobsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Varnum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soren","family":"Overgaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikkel","family":"Rathsach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Lindberg-Larsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel Josef","family":"Bieder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"issue":"5","key":"426_CR1","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1007\/s43441-022-00420-1","volume":"56","author":"SB Gasparyan","year":"2022","unstructured":"Gasparyan SB, Buenconsejo J, Kowalewski EK, Oscarsson J, Bengtsson OF, Esterline R, et al. Design and analysis of studies based on hierarchical composite endpoints: insights from the DARE-19 trial. Ther Innov Regul Sci. 2022;56(5):785\u201394.","journal-title":"Ther Innov Regul Sci"},{"key":"426_CR2","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1111\/trf.17735","volume":"64","author":"CC J\u00f8rgensen","year":"2024","unstructured":"J\u00f8rgensen CC, Michelsen C, Petersen T, Kehlet H. Preoperative hemoglobin thresholds for increased risk of \u201cmedical\u201d complications in fast-track total hip and knee arthroplasty, a secondary analysis of a machine-learning algorithm. Transfusion. 2024;64:438.","journal-title":"Transfusion"},{"issue":"Suppl 1","key":"426_CR3","first-page":"e54","volume":"75","author":"H Kehlet","year":"2020","unstructured":"Kehlet H. Enhanced postoperative recovery: good from afar, but far from good? Anaesthesia. 2020;75(Suppl 1):e54\u201361.","journal-title":"Anaesthesia"},{"issue":"4","key":"426_CR4","doi-asserted-by":"publisher","first-page":"102510","DOI":"10.1016\/j.eclinm.2024.102510","volume":"70","author":"H Kehlet","year":"2024","unstructured":"Kehlet H, Lobo D. Exploring the need for reconsideration of trial design in perioperative outcomes research: a narrative review. EClinicalMedicine. 2024;70(4):102510.","journal-title":"EClinicalMedicine"},{"issue":"1","key":"426_CR5","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s13741-023-00319-x","volume":"12","author":"JOM Plumb","year":"2023","unstructured":"Plumb JOM, Otto JM, Kumar SB, Bali S, Wakatsuki M, Schmidt WFJ, et al. Cardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical study. Perioper Med (lond). 2023;12(1):31.","journal-title":"Perioper Med (lond)"},{"issue":"3","key":"426_CR6","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1111\/anae.15926","volume":"78","author":"T Richards","year":"2023","unstructured":"Richards T, Miles LF, Clevenger B, Keegan A, Abeysiri S, Rao Baikady R, et al. The association between iron deficiency and outcomes: a secondary analysis of the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial. Anaesthesia. 2023;78(3):320\u20139.","journal-title":"Anaesthesia"},{"issue":"10","key":"426_CR7","doi-asserted-by":"publisher","first-page":"e036592","DOI":"10.1136\/bmjopen-2019-036592","volume":"10","author":"AB Scrimshire","year":"2020","unstructured":"Scrimshire AB, Booth A, Fairhurst C, Kotze A, Reed M, McDaid C. Preoperative iron treatment in anaemic patients undergoing elective total hip or knee arthroplasty: a systematic review and meta-analysis. 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Acta Orthop. 2022;93:739\u201341.","journal-title":"Acta Orthop"}],"container-title":["Perioperative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13741-024-00426-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13741-024-00426-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13741-024-00426-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T13:06:09Z","timestamp":1718975169000},"score":1,"resource":{"primary":{"URL":"https:\/\/perioperativemedicinejournal.biomedcentral.com\/articles\/10.1186\/s13741-024-00426-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,21]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["426"],"URL":"https:\/\/doi.org\/10.1186\/s13741-024-00426-3","relation":{},"ISSN":["2047-0525"],"issn-type":[{"value":"2047-0525","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,21]]},"assertion":[{"value":"4 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 June 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 June 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All patients provided informed consent to complete questionnaires and allow access to their medical records. No ethical approval was needed as non-interventional observational studies are exempt from ethics approval according to Danish law.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"CJ and HK have received personal speakers\u2019 fees from Pharmacosmos.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"60"}}