Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Systematic Reviews
Published in: Systematic Reviews 1/2024

Open Access 01-12-2024 | Iron Deficiency | Research

Reported outcomes in patients with iron deficiency or iron deficiency anemia undergoing major surgery: a systematic review of outcomes

Authors: Stephanie Stangl, Maria Popp, Stefanie Reis, Magdalena Sitter, Lena Saal-Bauernschubert, Selina Schießer, Peter Kranke, Suma Choorapoikayil, Stephanie Weibel, Patrick Meybohm

Published in: Systematic Reviews | Issue 1/2024

Login to get access

Abstract

Background

Iron deficiency (ID) is the leading cause of anemia worldwide. The prevalence of preoperative ID ranges from 23 to 33%. Preoperative anemia is associated with worse outcomes, making it important to diagnose and treat ID before elective surgery. Several studies indicated the effectiveness of intravenous iron supplementation in iron deficiency with or without anemia (ID(A)). However, it remains challenging to establish reliable evidence due to heterogeneity in utilized study outcomes. The development of a core outcome set (COS) can help to reduce this heterogeneity by proposing a minimal set of meaningful and standardized outcomes. The aim of our systematic review was to identify and assess outcomes reported in randomized controlled trials (RCTs) and observational studies investigating iron supplementation in iron-deficient patients with or without anemia.

Methods

We searched MEDLINE, CENTRAL, and ClinicalTrials.gov systematically from 2000 to April 1, 2022. RCTs and observational studies investigating iron supplementation in patients with a preoperative diagnosis of ID(A), were included. Study characteristics and reported outcomes were extracted. Outcomes were categorized according to an established outcome taxonomy. Quality of outcome reporting was assessed with a pre-specified tool. Reported clinically relevant differences for sample size calculation were extracted.

Results

Out of 2898 records, 346 underwent full-text screening and 13 studies (five RCTs, eight observational studies) with sufficient diagnostic inclusion criteria for iron deficiency with or without anemia (ID(A)) were eligible. It is noteworthy to mention that 49 studies were excluded due to no confirmed diagnosis of ID(A). Overall, 111 outcomes were structured into five core areas including nine domains. Most studies (92%) reported outcomes within the ‘blood and lymphatic system’ domain, followed by “adverse event” (77%) and “need for further resources” (77%). All of the latter reported on the need for blood transfusion. Reported outcomes were heterogeneous in measures and timing. Merely, two (33%) of six prospective studies were registered prospectively of which one (17%) showed no signs of selective outcome reporting.

Conclusion

This systematic review comprehensively depicts the heterogeneity of reported outcomes in studies investigating iron supplementation in ID(A) patients regarding exact definitions and timing. Our analysis provides a systematic base for consenting to a minimal COS.

Systematic review registration

PROSPERO CRD42020214247
Appendix
Available only for authorised users
Literature
1.
World Health O. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: World Health Organization; 2011.
2.
Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545–602.CrossRef
3.
Judd L, Hof L, Beladdale L, Friederich P, Thoma J, Wittmann M, et al. Prevalence of pre-operative anaemia in surgical patients: a retrospective, observational, multicentre study in Germany. Anaesthesia. 2022;77(11):1209–18.CrossRefPubMed
4.
Tonino RPB, Wilson M, Zwaginga JJ, Schipperus MR. Prevalence of iron deficiency and red blood cell transfusions in surgical patients. Vox Sang. 2022;117(3):379–85.CrossRefPubMed
5.
Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg. 2015;102(11):1314–24.CrossRefPubMed
6.
Muñoz M, Gómez-Ramírez S, Campos A, Ruiz J, Liumbruno GM. Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfus. 2015;13(3):370.PubMedPubMedCentral
7.
WHO guidelines approved by the guidelines review committee. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: World Health Organization © World Health Organization 2020; 2020.
8.
Peyrin-Biroulet L, Williet N, Cacoub P. Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review. Am J Clin Nutr. 2015;102(6):1585–94.CrossRefPubMed
9.
Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery: developed by the task force for cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology (ESC) Endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC). Eur Heart J. 2022;43(39):3826–924.CrossRefPubMed
10.
Meybohm P, Choorapoikayil S, Regaei A, Jung-König M, Zacharowski K. Patient blood management. ISBT Sci Ser. 2019;14(1):53–7.CrossRef
11.
Neef V, Choorapoikayil S, Piekarski F, Schlesinger T, Meybohm P, Zacharowski K. Current concepts in the evaluation and management of preoperative anemia. Curr Opin Anaesthesiol. 2021;34(3):352–6.CrossRefPubMed
12.
Elhenawy AM, Meyer SR, Bagshaw SM, MacArthur RG, Carroll LJ. Role of preoperative intravenous iron therapy to correct anemia before major surgery: a systematic review and meta-analysis. Syst Rev. 2021;10(1):36.CrossRefPubMedPubMedCentral
13.
14.
Van Remoortel H, Laermans J, Avau B, Bekkering G, Georgsen J, Manzini PM, et al. Effectiveness of iron supplementation with or without erythropoiesis-stimulating agents on red blood cell utilization in patients with preoperative anaemia undergoing elective surgery: a systematic review and meta-analysis. Transfus Med Rev. 2021;35(2):103–24.CrossRefPubMed
15.
Williamson PR, Altman DG, Bagley H, Barnes KL, Blazeby JM, Brookes ST, et al. The COMET handbook: version 1.0. Trials. 2017;18(3):1–50.
16.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021;372:n71.CrossRefPubMedPubMedCentral
17.
18.
Dodd S, Clarke M, Becker L, Mavergames C, Fish R, Williamson PR. A taxonomy has been developed for outcomes in medical research to help improve knowledge discovery. J Clin Epidemiol. 2018;96:84–92.CrossRefPubMedPubMedCentral
19.
20.
Harman NL, Bruce IA, Callery P, Tierney S, Sharif MO, O'Brien K, et al. MOMENT--Management of Otitis Media with Effusion in Cleft Palate: protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey. Trials. 2013;14:70.CrossRefPubMedPubMedCentral
21.
Froessler B, Palm P, Weber I, Hodyl NA, Singh R, Murphy EM. The important role for intravenous iron in perioperative patient blood management in major abdominal surgery: a randomized controlled trial. Ann Surg. 2016;264(1):41.CrossRefPubMed
22.
Kim YH, Chung HH, Kang SB, Kim SC, Kim YT. Safety and usefulness of intravenous iron sucrose in the management of preoperative anemia in patients with menorrhagia: a phase IV, open-label, prospective, randomized study. Acta Haematol. 2009;121(1):37–41.CrossRefPubMed
23.
Lee S, Ryu K-J, Lee ES, Lee KH, Lee JJ, Kim T. Comparative efficacy and safety of intravenous ferric carboxymaltose and iron sucrose for the treatment of preoperative anemia in patients with menorrhagia: an open-label, multicenter, randomized study. J Obstet Gynaecol Res. 2019;45(4):858–64.CrossRefPubMed
24.
Na H-S, Shin S-Y, Hwang J-Y, Jeon Y-T, Kim C-S, Do S-H. Effects of intravenous iron combined with low-dose recombinant human erythropoietin on transfusion requirements in iron-deficient patients undergoing bilateral total knee replacement arthroplasty (CME). Transfusion. 2011;51(1):118–24.CrossRefPubMed
25.
Thin TN, Tan BPY, Sim EY, Shum KL, Chan HSP, Abdullah HR. Preoperative single-dose intravenous iron formulation to reduce postsurgical complications in patients undergoing major abdominal surgery: a randomized control trial feasibility study (PIRCAS Trial Pilot). Cureus. 2021;13(8):e17357.PubMedPubMedCentral
26.
Nandhra S, Chau M, Klein AA, Yeates JA, Collier T, Evans C, et al. Preoperative anaemia management in patients undergoing vascular surgery. Br J Surg. 2020;107(12):1558–61.PubMed
27.
Klein AA, Chau M, Yeates JA, Collier T, Evans C, Agarwal S, et al. Preoperative intravenous iron before cardiac surgery: a prospective multicentre feasibility study. Br J Anaesth. 2020;124(3):243–50.CrossRefPubMed
28.
Abdullah HR, Thamnachit T, Hao Y, Lim WY, Teo LM, Sim YE. Real-world results of the implementation of preoperative anaemia clinic with intravenous iron therapy for treating iron-deficiency anaemia: a propensity-matched case-control study. J Transl Med. 2020;9(1):6.
29.
D'Amato T, Kon E, Martorelli F, Monteleone G, Simili V, Tasso F, et al. Effect of intravenous ferric carboxymaltose supplementation in non-anaemic iron deficient patients undergoing hip and knee arthroplasty. J Biol Regul Homeost Agents. 2020;34(4 Suppl. 3):69–77. Congress of the Italian Orthopaedic Research Society.PubMed
30.
Ionescu A, Sharma A, Kundnani NR, Mihăilescu A, David VL, Bedreag O, et al. Intravenous iron infusion as an alternative to minimize blood transfusion in peri-operative patients. Sci Rep. 2020;10(1):18403.CrossRefPubMedPubMedCentral
31.
Laso-Morales M, Jericó C, Gómez-Ramírez S, Castellví J, Viso L, Roig-Martínez I, et al. Preoperative management of colorectal cancer–induced iron deficiency anemia in clinical practice: data from a large observational cohort. Transfusion. 2017;57(12):3040–8.CrossRefPubMed
32.
Scardino M, Di Matteo B, Martorelli F, Tanzi D, Kon E, D’Amato T. Improved patient blood management and cost saving in hip replacement surgery through the implementation of pre-operative Sucrosomial® iron supplementation: a quality improvement assessment study. Int Orthop. 2019;43(1):39–46.CrossRefPubMed
33.
Shin K-H, Park J-H, Jang K-M, Hong S-H, Han S-B. Effects of intravenous iron monotherapy for patients with iron deficient anemia undergoing total knee arthroplasty. Arthroplasty. 2020;2(1):22.CrossRefPubMedPubMedCentral
34.
The Helsinki Declaration of the World Medical Association (WMA). Ethical principles of medical research involving human subjects. Pol Merkur Lekarski. 2014;36(215):298–301.
35.
Shander A, Corwin HL, Meier J, Auerbach M, Bisbe E, Blitz J, et al. Recommendations from the International Consensus Conference on Anemia Management in Surgical Patients (ICCAMS). Ann Surg. 2022;277(4):581–90.CrossRefPubMed
36.
Kaufner L, von Heymann C, Henkelmann A, Pace NL, Weibel S, Kranke P, et al. Erythropoietin plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery. Cochrane Database Syst Rev. 2020;8(8):Cd012451.PubMed
37.
Triphaus C, Judd L, Glaser P, Goehring MH, Schmitt E, Westphal S, et al. Effectiveness of preoperative iron supplementation in major surgical patients with iron deficiency: a prospective observational study. Ann Surg. 2021;274(3):e212–9.CrossRefPubMed
38.
Richards T, Baikady RR, Clevenger B, Butcher A, Abeysiri S, Chau M, et al. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial. Lancet. 2020;396(10259):1353–61.CrossRefPubMedPubMedCentral
39.
Malinowski AK, D'Souza R, Khan KS, Shehata N, Malinowski M, Daru J. Reported outcomes in perinatal iron deficiency anemia trials: a systematic review. Gynecol Obstet Investig. 2019;84(5):417–34.CrossRef
40.
Moussa R, Rada MP, Durnea C, Falconi G, Betschart C, Haddad JM, et al. Outcome reporting in randomized controlled trials (RCTs) on the pharmacological management of idiopathic overactive bladder (OAB) in women; a systematic review for the development of core outcome sets (COS). Int Urogynecol J. 2022;33(5):1243–50.CrossRefPubMedPubMedCentral
41.
Tellum T, Omtvedt M, Naftalin J, Hirsch M, Jurkovic D. A systematic review of outcome reporting and outcome measures in studies investigating uterine-sparing treatment for adenomyosis. Hum Reprod Open. 2021;2021(3):hoab030.CrossRefPubMedPubMedCentral
Metadata
Title
Reported outcomes in patients with iron deficiency or iron deficiency anemia undergoing major surgery: a systematic review of outcomes
Authors
Stephanie Stangl
Maria Popp
Stefanie Reis
Magdalena Sitter
Lena Saal-Bauernschubert
Selina Schießer
Peter Kranke
Suma Choorapoikayil
Stephanie Weibel
Patrick Meybohm
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2024
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-023-02431-x

Other articles of this Issue 1/2024

Systematic Reviews 1/2024 Go to the issue

Research

Association between frailty and clinical outcomes in patients undergoing craniotomy—systematic review and meta-analysis of observational studies

Research

Effectiveness of gold nanoparticles in prevention and treatment of oral mucositis in animal models: a systematic review

Protocol

Factors influencing health-related quality of life among long-term care residents experiencing pain: a systematic review protocol

Research

The secretor status of blood group antigens in the saliva in people with oral cancers: a systematic review

Protocol

Exploring the biopsychosocial impact of hypermobility spectrum disorders and Ehlers-Danlos syndrome in an adult population: a protocol for a scoping review

Research

Role of hydroxyurea therapy in the prevention of organ damage in sickle cell disease: a systematic review and meta-analysis