• Rishubh Jain, Michael J Farias, Manjot Singh, Claire Pisani, Joseph E Nassar, Bassel G Diebo, and Alan H Daniels.
• Warren Alpert Medical School, Brown University, Providence, RI.
• Spine. 2025 Feb 11.

Study DesignRetrospective cohort study.ObjectiveEvaluate postoperative outcomes in lumbar fusion patients with preoperative iron deficiency anemia (IDA) on iron supplementation.BackgroundIDA has been associated with impaired cognition, compromised immune response, and increased risk of morbidity and mortality following surgery. However, little is known about the relationship between IDA and postoperative complications among patients undergoing lumbar fusion, as well as about the impact of preoperative iron supplementation on these outcomes.MethodsA national all-payer claims database was queried for adult patients who underwent lumbar spinal fusion between 2010 to 2022. Patients were initially stratified by a preoperative diagnosis of IDA and matched 1:1 based on age, sex, and medical comorbidities. IDA patients were further stratified by preoperative iron supplementation use and similarly matched. Postoperative complications and hospital costs were compared using chi-square, t-test, and multivariate logistic regressions.ResultsThe matched cohorts consisted of 27,669 patients, with mean age of 59 years and 89% female sex. IDA patients had higher rates of pulmonary embolism, acute kidney infection, deep venous thromboembolism, surgical site infection, urinary tract infection, blood transfusion, 90-day readmission rates, and hospital length of stay (all P<0.001). IDA patients on preoperative iron supplementation had lower rates of acute kidney injury, hematoma, pulmonary embolism, surgical site infection, urinary tract infection, stroke, 90-day readmission rates, and 90-day total hospital costs (all P<0.001). Non-IDA patients on preoperative iron supplementation similarly had lower rates of many of these complications as well.ConclusionIDA was associated with increased risk of 90-day postoperative medical complications and hospital resource utilization. However, preoperative oral iron supplementation mitigated these risks. Further research is critical to understand how pre- or peri-operative iron supplementation can be used to optimize patients' hematologic status before lumbar fusion to maximize clinical outcomes.Level Of EvidenceIV.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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