The Effect of Perioperative Iron Therapy in Acute Major Non‐cardiac Surgery on Allogenic Blood Transfusion and Postoperative Haemoglobin Levels: A Systematic Review and Meta‐analysis

Abstract

Background Perioperative anaemia in relation to surgery is associated with adverse clinical outcomes. In an elective surgical setting, it is possible to optimize patients prior to surgery, often by iron supplementation with correction of anaemia. Possibilities for optimization prior to and during acute surgical procedures are limited. This review investigates whether iron treatment initiated perioperatively improves outcomes in patients undergoing major acute non‐cardiac surgery. Method This systematic review was performed using PubMed, EMBASE (Ovid) and Scopus to identify current evidence on iron supplementation in acute surgery. Primary outcomes were allogenic blood transfusion (ABT) rate and changes in haemoglobin. Secondary outcomes were postoperative mortality, length of stay (LOS), and postoperative complications. Iron was administered at latest within 24 h after end of surgery. Results Of the 5413 studies screened, four randomized controlled trials and nine observational cohort studies were included. Ten studies included patients with hip fractures. A meta‐analysis of seven studies showed a risk reduction of transfusion (OR = 0.35 CI 95% (0.20–0.63), p = 0.0004, I2 = 66%). No influence on plasma haemoglobin was found. Postoperative mortality was reduced in the iron therapy group in a meta‐analysis of four observational studies (OR 0.50 (CI 95% 0.26–0.96) p = 0.04). No effect was found on LOS, but a reduction in postoperative infection was seen in four studies. Conclusions This review examined perioperative iron therapy in acute major non‐cardiac surgery. IV iron showed a lower 30‐day mortality, a reduction in postoperative infections and a reduction in ABT largely due to the observational studies. The review primarily consisted of small observational studies and does not have the power to formally recommend this practice.

Role of preoperative intravenous iron therapy to correct anemia before major surgery: a systematic review and meta-analysis

“…Therefore, in this meta-analysis, it would seem that after receiving IV iron, a reduction of 16% in the proportion of patients requiring ABT might be considered clinically important and sufficient to change patient management. This transfusion reduction in our study is in accordance with previous large meta-analysis of both surgical and nonsurgical RCTs [50], a recent surgical meta-analysis [51], several observational studies [52][53][54][55][56][57][58][59][60][61], and a pooled analysis of observational data from 2547 patients [62]. This finding is of great benefit for all patients, including Jehovah's Witness (JW) patients, where ABT is forbidden, patients who will be potentially organ recipients, patients for whom transfusions are medically contraindicated, and those who are living in countries with restricted resources.…”

Postoperative anaemia might be a risk factor for postoperative delirium and prolonged hospital stay: A secondary analysis of a prospective cohort study

“…higher rate of mortality and morbidity [39], neuroinflammation and cognitive impairment [40]), the utilization of effective remedies like iron infusions [35,41], tranexamic acid [42], bipolar sealer [43] and cell-saver [44] to avoid allogenic blood transfusion should be fully exhausted [45]. For example, a perioperative iron therapy showed a lower 30-day mortality rate and a reduction in blood transfusions [46]. The perioperative use of tranexamic acid preserved a higher postoperative HB level reducing the length of hospitalisation [47].…”

Incidence of Iron Deficiency and the Role of Intravenous Iron Use in Perioperative Periods

“…A decrease in 30-days mortality, allogenic blood transfusion, and a lower rate of postoperative infections were observed. After the analysis, no statistical difference was observed with regards to the postoperative hemoglobin level or the hospital’s length of stay [ 36 ].…”