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Perioperatives Anämiemanagement – Systematischer Review und Meta-Analyse

Perioperative anemia management: a systematic review and meta-analysis

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Zusammenfassung

Anämie ist ein Risikofaktor für erhöhte postoperative Morbidität und Mortalität. Internationale Leitlinien empfehlen daher präoperative Diagnostik und kausale Therapie von Anämien. Bei tumorassoziierter Anämie besteht jedoch der Verdacht, dass Eisentherapie zu einer rascheren Progression des Krankheitsverlaufs führen könnte. Ziel unserer systematischen Übersichtsarbeit war die Wirksamkeit und Sicherheit von Interventionen zur Abklärung und kausalen Therapie von perioperativen Anämien zu untersuchen und den Einfluss von Eisenpräparaten auf den Verlauf von Tumorerkrankungen zu erheben.

Wir führten systematische Literatursuchen in mehreren elektronischen Datenbanken durch. Abstracts und Volltexte wurden von zwei Personen unabhängig voneinander beurteilt. Die Einschätzung des Bias-Risikos erfolgte nach Vorgaben der Cochrane Collaboration, die Beurteilung der Qualität der Evidenz nach GRADE (Grading Recommendations Assessment, Development and Evaluation). Meta-Analysen wurden mit zufälligen Effekten nach DerSimonian&Laird berechnet. Ergebnisse zeigten, dass eine präoperative Anämietherapie zur Reduktion von Bluttransfusionen führen kann (relatives Risiko: 0,78, 95 % KI 0,61–1,02; number needed to treat: 6). Für andere patientenrelevante Endpunkte zeigten Ergebnisse aufgrund der geringen Fallzahlen keine klaren Unterschiede. Wir konnten keine Evidenz finden, dass orale Eisengabe den Verlauf von Tumorerkrankungen beeinflusst.

Summary

Anemia is a risk factor for increased postoperative morbidity and mortality. International guidelines, therefore, recommend preoperative diagnostic work up and causal treatment of anemia. Iron therapy, however, is suspected to negatively affect disease progression in patients with cancer-associated anemia. The objective of our systematic review was to assess the efficacy and safety of perioperative diagnosis and causal therapy of anemia, and to determine the effect of iron supplement on disease progression of cancer.

We systematically searched multiple electronic databases. Two persons independently reviewed abstracts and full-text articles. We rated the risk of bias using the Cochrane Risk of Bias Tool and assessed the quality of the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Meta-Analyses were performed using the DerSimonian&Laird random effects method.

Results indicate that preoperative therapy of anemia could reduce the need for blood transfusions (relative risk: 0,78; 95 % confidence interval 0,61–1,02; number needed to treat: 6) For other patient-relevant outcomes the number of events were too small to detect clinically relevant differences. We could not find any evidence that iron supplements have an influence on the progression of tumors.

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Danksagung

Ein besonderer Dank gilt Frau Evelyn Auer vom Department für Evidenzbasierte Medizin und Klinische Epidemiologie, für die administrative Unterstützung.

Fördermittel

Österreichische Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin ÖGARI

Interessenkonflikt

Die Autoren erklären, dass kein Interessenkonflikt vorliegt.

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Authors and Affiliations

  1. Department für Klinische Epidemiologie und Evidenzbasierte Medizin, Donau-Universität Krems, Krems, Österreich

    Anna Glechner,  Gerald Gartlehner MPH & Barbara Nußbaumer Bakk. BSc, MSc

  2. Research Triangle Institute (RTI)-International, Research Triangle Park, Durham, North Carolina, USA

    Gerald Gartlehner MPH

  3. Österreichischen Gesellschaft für Anaesthesiologie, Reanimation und Intensivmedizin (ÖGARI), Wien, Österreich

    Sibylle Kozek-Langenecker MBA

  4. Abteilung für Anästhesie und Intensivmedizin, Evangelisches Krankenhaus Wien, Wien, Österreich

    Sibylle Kozek-Langenecker MBA

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  1. Anna Glechner
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Correspondence to Anna Glechner.

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Glechner, A., Gartlehner, G., Nußbaumer, B. et al. Perioperatives Anämiemanagement – Systematischer Review und Meta-Analyse. Wien Med Wochenschr 164, 330–341 (2014). https://doi.org/10.1007/s10354-014-0293-x

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  • DOI: https://doi.org/10.1007/s10354-014-0293-x

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