Role of preoperative erythropoietin in the optimization of preoperative anemia among surgical patients — A systematic review and meta-analysis

Ali, Sheikh Muhammad Ebad; Hafeez, Muhammad Hassan; Nisar, Omar; Fatima, Sarosh; Ghous, Humaira; Rehman, Mahwish

doi:10.1016/j.htct.2020.12.006

Cited by 9 publications

(9 citation statements)

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“…Three other recent systematic reviews synthesized the adverse events, including the impact on clinically important outcomes, of oral/IV iron supplementation with or without ESAs in patients with preoperative anemia undergoing elective surgery. These reviews found no statistically significant difference in complications and 90-day mortality, 29 no important differences in the risk of adverse events (e.g., renal dysfunction, thromboembolism, hypertension, allergic reaction, headache, fever, constipation), or mortality within 30 days. 31 Another systematic review and meta-analysis of 154 RCTs found that intravenous iron was associated with an increased risk of infection when compared with oral iron or no iron (RR: 1.17, 95% CI: 1.04–1.31, moderate certainty-evidence) and there was no evidence of an effect on mortality.…”

Section: Comparison With Other Recent Systematic Reviews and Meta-ana...mentioning

confidence: 95%

“…Seven recently published systematic reviews with metaanalyses of RCTs answered a similar PICO question and confirmed our conclusions regarding no effect of preoperative iron monotherapy [25][26][27][28] or a reduced effect of ESAs in addition to oral/IV iron supplementation on blood transfusion rate. [29][30][31] On the contrary, one review found that IV iron supplementation is associated with a significant decrease in blood transfusion rate in both anemic and nonanemic patients undergoing major elective surgery. 32 However, the data of the PREVENTT trial 33 were not in the meta-analysis of this review, because this trial was ongoing at the time this review was conducted.…”

Section: Comparison With Other Recent Systematic Reviews and Meta-ana...mentioning

confidence: 99%

“…Seven recently published systematic reviews with meta-analyses of RCTs answered a similar PICO question and confirmed our conclusions regarding no effect of preoperative iron monotherapy 25 26 27 28 or a reduced effect of ESAs in addition to oral/IV iron supplementation on blood transfusion rate. 29 30 31…”

Section: Comparison With Other Recent Systematic Reviews and Meta-ana...mentioning

confidence: 99%

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Evidence-Based Medicine: Principles and Values as Illustrated by the Case of Patient Blood Management

et al. 2023

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Evidence-based medicine is considered 1 of the 15 great inventions in medicine. It aims to remove bias in medical decision-making as much as possible through a rigorous process. In this article, the principles of evidence-based medicine are illustrated using the case of patient blood management (PBM). Acute or chronic bleeding, iron deficiency, and renal and oncological diseases may lead to preoperative anemia. To compensate for severe and life-threatening blood loss during surgery, doctors transfuse red blood cells (RBCs). PBM is an approach to take care of patients at risk for anemia, which includes detecting and treating anemia before surgery. Alternative interventions to treat preoperative anemia are the use of iron supplementation with or without erythro-stimulating agents (ESAs). The best available scientific evidence today indicates that preoperative intravenous (IV) or oral iron monotherapy may not be effective to reduce RBC utilization (low-certainty evidence). Preoperative IV iron supplementation in addition to ESAs is probably effective to reduce RBC utilization (moderate-certainty evidence), whereas oral iron supplementation in addition to ESAs may be effective to reduce RBC utilization (low-certainty evidence). The adverse events of preoperative oral/IV iron and/or ESAs and their impact on patient-important outcomes (morbidity, mortality, quality of life) remain unclear (very low-certainty evidence). Since PBM is a patient-centered approach, emphasis on monitoring and evaluation of patient-important outcomes in future research is urgently needed. Finally, the cost-effectiveness of preoperative oral/IV iron monotherapy is unproven, whereas preoperative oral/IV iron in addition to ESAs is extremely cost-ineffective.

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Section: Comparison With Other Recent Systematic Reviews and Meta-ana...mentioning

confidence: 95%

Section: Comparison With Other Recent Systematic Reviews and Meta-ana...mentioning

confidence: 99%

Section: Comparison With Other Recent Systematic Reviews and Meta-ana...mentioning

confidence: 99%

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Evidence-Based Medicine: Principles and Values as Illustrated by the Case of Patient Blood Management

et al. 2023

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“…Although some institutions have established preoperative anemia clinics streamlined to provide anemia managements,99,104 it is crucial to provide a preoperative optimization process to test, diagnose, and treat anemia even if such entity is not available. Hematology and medical oncology or internal medicine consultation may be utilized to provide intravenous iron administration and erythropoiesis-stimulating agents in addition to nutritional managements 105…”

Section: Preoperative Optimization For Frail Patientsmentioning

confidence: 99%

“…Hematology and medical oncology or internal medicine consultation may be utilized to provide intravenous iron administration and erythropoiesis-stimulating agents in addition to nutritional managements. 105…”

Section: Tablementioning

confidence: 99%

Preoperative optimization of geriatric and frail patients

Pai

Jacob

Wang

2021

International Anesthesiology Clinics

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The United States Census Bureau has projected that adults 65 years and older will outnumber the population under the age of 18 years by 2034. 1 It has also projected that 1 in every 5 US residents will be retirement age by 2030. 2 The increasing number of geriatric patients globally alters the demographics of those seeking medical treatments, including surgical care. As a result, anesthesiologists now frequently face the challenge of caring for frail surgical patients with multiple comorbidities, malnutrition, low functional capacity, and cognitive impairment. 3 Typically, frailty is used to describe the condition of being weak and delicate associated with old age. However, medically, frailty is defined as a state of reduced physiological reserve associated with increased susceptibility to disability and inability to cope with stressors such as surgery. 4 It has been described as a multidimensional syndrome characterized by increased clinical vulnerability. 5 In addition to its negative impacts to patients' inflammatory, metabolic, and immune responses to surgery, frailty also reduces sympathetic reserves, impairing intraoperative hemodynamic responses. 6,7 While frailty is independent of the chronological age of a patient, it is predominantly found in the geriatric population. 8 Santos-Eggimann et al 9 estimated that frailty affects 4% of middle-aged people and 17% of people older than 65 years in the European population. The prevalence of frailty in the geriatric surgical population is estimated to be between 10% and 37%. 5

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Uterine Cancer Surgery

Avila,

Kotha

2023

Anesthesia for Oncological Surgery

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Role of preoperative erythropoietin in the optimization of preoperative anemia among surgical patients — A systematic review and meta-analysis

Cited by 9 publications

References 52 publications

Evidence-Based Medicine: Principles and Values as Illustrated by the Case of Patient Blood Management

Evidence-Based Medicine: Principles and Values as Illustrated by the Case of Patient Blood Management

Preoperative optimization of geriatric and frail patients

Uterine Cancer Surgery

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