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Perioperative Medicine
Published in: Perioperative Medicine 1/2018

Open Access 01-12-2018 | Research

What is the effect of perioperative intravenous iron therapy in patients undergoing non-elective surgery? A systematic review with meta-analysis and trial sequential analysis

Authors: Akshay Shah, Antony J. R. Palmer, Sheila A. Fisher, Shah M. Rahman, Susan Brunskill, Carolyn Doree, Jack Reid, Anita Sugavanam, Simon J. Stanworth

Published in: Perioperative Medicine | Issue 1/2018

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Abstract

Background

Guidelines to treat anaemia with intravenous (IV) iron have focused on elective surgical patients with little attention paid to those undergoing non-elective/emergency surgery. Whilst these patients may experience poor outcomes because of their presenting illness, observational data suggests that untreated anaemia may also be a contributing factor to poor outcomes. We conducted a systematic review to investigate the safety and efficacy of IV iron in patients undergoing non-elective surgery.

Methods

We followed a pre-defined review protocol and included randomised controlled trials (RCTs) in patients undergoing non-elective surgery who received IV iron. Primary outcomes were all-cause infection and mean difference in haemoglobin (Hb) at follow-up. Secondary outcomes included transfusion requirements, hospital length of stay (LOS), health-related quality of life (HRQoL), mortality and adverse events.

Results

Three RCTs (605 participants) were included in this systematic review of which two, in both hip fracture (HF) patients, provided data for meta-analysis. Both of these RCTs were at low risk of bias. We found no evidence of a difference in the risk of infection (RR 0.99, 95% CI 0.55 to 1.80, I2 = 9%) or in the Hb concentration at ‘short-term’ (≤ 7 days) follow-up (mean difference − 0.32 g/L, 95% CI − 3.28 to 2.64, I2 = 37%). IV iron did not reduce the risk of requiring a blood transfusion (RR 0.90, 95% CI 0.73 to 1.11, p = 0.46, I2 = 0%), and we observed no difference in mortality, LOS or adverse events. One RCT reported on HRQoL and found no difference between treatment arms.

Conclusion

We found no conclusive evidence of an effect of IV iron on clinically important outcomes in patients undergoing non-elective surgery. Further adequately powered trials to evaluate its benefit in emergency surgical specialties with a high burden of anaemia are warranted.

Trial registration

This systematic review was registered on PROSPERO (CRD42018096288)
Appendix
Available only for authorised users
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Metadata
Title
What is the effect of perioperative intravenous iron therapy in patients undergoing non-elective surgery? A systematic review with meta-analysis and trial sequential analysis
Authors
Akshay Shah
Antony J. R. Palmer
Sheila A. Fisher
Shah M. Rahman
Susan Brunskill
Carolyn Doree
Jack Reid
Anita Sugavanam
Simon J. Stanworth
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Perioperative Medicine / Issue 1/2018
Electronic ISSN: 2047-0525
DOI
https://doi.org/10.1186/s13741-018-0109-4

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