Why the study?
Guidelines for treating anaemia with intravenous iron have focused on elective surgery with little attention to non-elective surgery, where untreated anaemia may contribute to poor outcomes.
Does perioperative intravenous iron therapy reduce infection or improve haemoglobin in patients undergoing non-elective surgery?
Does perioperative intravenous iron therapy reduce infection or improve haemoglobin in patients undergoing non-elective surgery?
Answers are grounded in this paper and cite their sources.
Perioperative intravenous iron therapy does not significantly improve haemoglobin levels, reduce infection risk, or decrease transfusion requirements in patients undergoing non-elective surgery.
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. 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. 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. 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. This systematic review was registered on PROSPERO ( CRD42018096288 )
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Shah et al. (2018) studied this question.
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