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Post-Operative Intravenous Iron Sucrose Versus Post-Operative Oral Iron to Treat Post-Bariatric Abdominoplasty Anaemia (ISAPA)

A Prospective, Open-Label, Randomised Controlled Trial

Montano-Pedroso, Juan Carlos, MD, PhD; Garcia, Elvio Bueno, MD, PhD; Rodrigues de Moraes, Mariana Alcantara, MD; Veiga, Daniela Francescato, PhD; Ferreira, Lydia Masako, PhD

Plastic and Reconstructive Surgery – Global Open: August 2018 - Volume 6 - Issue 8S - p 103–104
doi: 10.1097/01.GOX.0000546958.79634.22
PSTM 2018 Abstract Supplement
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Federal University of SÃo Paulo, Sao Paulo

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BACKGROUND: Anaemia and iron deficiency are common following post-bariatric abdominoplasty.1 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 patients.2

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 mortality.3 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 recommended.4 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 time.5


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.

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.