Efficacy of perioperative intravenous iron therapy for transfusion in orthopedic surgery: A systematic review and meta-analysis

• Published in: PloS one 2019-05, Vol.14 (5), p.e0215427-e0215427
• Main Authors: Shin, Hye Won, Park, Jeong Jun, Kim, Hyun Jung, You, Hae Sun, Choi, Sung Uk, Lee, Mee Ju
• Format: Article
• Language: English
• Subjects: Anemia; Biology and Life Sciences; Blood cells; Blood transfusion; Blood Transfusion - statistics & numerical data; Care and treatment; Clinical trials; Erythrocytes; Ferric carboxymaltose; Humans; Infection; Infections; Infusions, Intravenous; Intravenous administration; Intravenous therapy; Iron; Iron - administration & dosage; Joint surgery; Length of Stay; Medical research; Medicine and Health Sciences; Meta-analysis; Mortality; Orthopedic Procedures - methods; Orthopedic surgery; Orthopedics; Patients; Perioperative Care - methods; Physical Sciences; Randomized Controlled Trials as Topic; Red blood cells; Research and Analysis Methods; Scientific papers; Search engines; Subgroups; Surgery; Systematic review; Therapy; Transfusion
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0215427

Perioperative anemia frequently occurs in patients undergoing orthopedic surgery. We aimed to evaluate the efficacy of perioperative intravenous iron therapy (IVIT) on transfusion and recovery profiles during orthopedic surgery. We searched PubMed, Embase, Cochrane, and Google Scholar for eligible clinical trials (randomized controlled trials, RCTs; case-control studies, CCSs) in comparing IVIT and no iron therapy, up to September 2018. Primary outcomes were the effects of IVIT on the proportion of patients transfused and units of red blood cells (RBCs) transfused perioperatively. Secondary outcomes were the effects of IVIT on recovery profiles, such as length of hospital stay (LOS), post-operative infection, and mortality. Subgroup analysis was performed based on iron dose (low: ≤ 300 mg, high: > 400 mg), IVIT period (pre-operative, post-operative, perioperative), and study design. We identified 12 clinical trials (4 RCTs with 616 patients and 8 CCSs with 1,253 patients). IVIT significantly reduced the proportion of patients transfused by 31% (RR, 0.69; P = 0.0002), and units of RBCs transfused by 0.34 units/person (MD, -0.34; P = 0.0007). For subgroup analysis by iron dose, low- or high-dose IVIT significantly reduced the proportion of patients transfused (RR, 0.73, P = 0.005; RR, 0.68, P = 0.008), and RBC units transfused (MD, -0.47, P < 0.0001; MD, -0.28, P = 0.04). For subgroup analysis by period, IVIT administered post-operatively significantly reduced the proportion of patients transfused (post-operative: RR, 0.60, P = 0.002; pre-operative: RR, 0.74, P = 0.06) and RBC units transfused (post-operative: MD, -0.44, P