Key result
Pre-operative iron significantly increased haemoglobin concentration by 0.81 g/dl before abdominal surgery but did not significantly reduce the need for peri-operative blood transfusion (RR 0.57).
Why the study?
Professional surgical societies recommend treating pre-operative anaemia before abdominal surgery, but the effects of pre-operative iron on haemoglobin correction and peri-operative transfusion remained to be determined.
Does pre-operative iron reduce the incidence of peri-operative blood transfusion in patients undergoing major abdominal surgery?
Meta-Analysis (n=651)
Does pre-operative iron reduce the incidence of peri-operative blood transfusion in patients undergoing major abdominal surgery?
Relative Risk: 0.57 (95% CI 0.3–1.09)
p-value: p=0.09
Pre-operative iron increases haemoglobin concentration before abdominal surgery but does not significantly reduce the need for peri-operative blood transfusion, though results are limited by heterogeneity and underpowered trials.
Pre-operative iron raises haemoglobin without reducing transfusions; challenges routine use and leaves transfusion benefit open.
Professional surgical societies recommend the identification and treatment of pre-operative anaemia in patients scheduled for abdominal surgery. Our aim was to determine if pre-operative iron allows correction of haemoglobin concentration and decreased incidence of peri-operative blood transfusion in patients undergoing major abdominal surgery. MEDLINE, Embase and CENTRAL were searched for RCTs written in English and assessing the effect of pre-operative iron on the incidence of peri-operative allogeneic blood transfusion in patients undergoing major abdominal surgery. Pooled relative risk (RR), risk difference (RD) and mean difference (MD) were obtained using models with random effects. Heterogeneity was assessed using the Q-test and quantified using the I 2 value. Four RCTs were retained for analysis out of 285 eligible articles. MD in haemoglobin concentration between patients with pre-operative iron and patients without pre-operative iron was of 0.81 g/dl (3 RCTs, 95% CI 0.30 to 1.33, I 2 : 60%, p = 0.002). Pre-operative iron did not lead to reduction in the incidence of peri-operative blood transfusion in terms of RD (4 RCTs, RD: − 0.13, 95% CI − 0.27 to 0.01, I 2 : 65%, p = 0.07) or RR (4 RCTs, RR: 0.57, 95% CI 0.30 to 1.09, I 2 : 64%, p = 0.09). To conclude, pre-operative iron significantly increases haemoglobin concentration by 0.81 g/dl before abdominal surgery but does not reduce the need for peri-operative blood transfusion. Important heterogeneity exists between existing RCTs in terms of populations and interventions. Future trials should target patients suffering from iron-deficiency anaemia and assess the effect of intervention on anaemia-related complications.
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Meyer et al. (2022) conducted a meta-analysis in major abdominal surgery (n=651). Pre-operative iron vs. no iron or placebo was evaluated on incidence of peri-operative allogeneic blood transfusion (RR 0.57, 95% CI 0.30 to 1.09, p=0.09). Pre-operative iron significantly increased haemoglobin concentration by 0.81 g/dl before abdominal surgery but did not significantly reduce the need for peri-operative blood transfusion (RR 0.57).
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