Why the study?
Preoperative optimization is limited in acute surgery, and it remained uncertain whether perioperative iron treatment improves outcomes in patients undergoing major acute non-cardiac surgery.
Does perioperative iron therapy reduce allogenic blood transfusion and improve haemoglobin levels in patients undergoing major acute non-cardiac surgery?
Does perioperative iron therapy reduce allogenic blood transfusion and improve haemoglobin levels in patients undergoing major acute non-cardiac surgery?
Perioperative IV iron therapy in acute major non-cardiac surgery may reduce 30-day mortality and postoperative infections, but current evidence from small observational studies is insufficient to formally recommend this practice.
May lower postoperative mortality in major non-cardiac surgery; hypothesis-generating from observational data, requiring RCTs before practice change.
BACKGROUND: Perioperative anaemia in relation to surgery is associated with adverse clinical outcomes. In an elective surgical setting, it is possible to optimize patients prior to surgery, often by iron supplementation with correction of anaemia. Possibilities for optimization prior to and during acute surgical procedures are limited. This review investigates whether iron treatment initiated perioperatively improves outcomes in patients undergoing major acute non-cardiac surgery. METHOD: This systematic review was performed using PubMed, EMBASE (Ovid) and Scopus to identify current evidence on iron supplementation in acute surgery. Primary outcomes were allogenic blood transfusion (ABT) rate and changes in haemoglobin. Secondary outcomes were postoperative mortality, length of stay (LOS), and postoperative complications. Iron was administered at latest within 24 h after end of surgery. RESULTS: = 66%). No influence on plasma haemoglobin was found. Postoperative mortality was reduced in the iron therapy group in a meta-analysis of four observational studies (OR 0.50 (CI 95% 0.26-0.96) p = 0.04). No effect was found on LOS, but a reduction in postoperative infection was seen in four studies. CONCLUSIONS: This review examined perioperative iron therapy in acute major non-cardiac surgery. IV iron showed a lower 30-day mortality, a reduction in postoperative infections and a reduction in ABT largely due to the observational studies. The review primarily consisted of small observational studies and does not have the power to formally recommend this practice.
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Schack et al. (2019) studied this question.
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