Preoperative iron supplementation in non-anemic patients undergoing major surgery: a systematic review and meta-analysis
Suplementação de ferro pré-operatória em pacientes não anêmicos submetidos a cirurgias de grande porte: uma revisão sistemática e meta-análise
Fabio Vieira Toledo, Daniel De Carli, Jose Fernando Amaral Meletti, Herman Yuri Almeida Togo, Italo Pires Gomes, Renato Makoto Sakashita, Lucas Felix Montes, Rafael Santos Tiburcio, Cesar de Araujo Miranda
Abstract
Background
Blood transfusions are associated with increased morbidity and mortality, and maintaining global blood supplies can be a challenge. This systematic review investigates the impact of preoperative iron supplementation on the risk of blood transfusion among non-anemic patients undergoing major surgeries.
Methods
We conducted a systematic search of PubMed, Embase, and Cochrane Central for randomized controlled trials published up to May 2024. Studies involving the use of erythropoietin, or patients already using iron supplementation when trial randomization was conducted were excluded. Outcomes assessed included the number of individuals who received blood transfusions, and mean hemoglobin levels at the first day and by the first postoperative week.
Results
A total of 1,162 non-anemic patients from 9 studies were included. Of these, 54% received preoperative iron supplementation. The average age was 71 years, and 44% were women. Preoperative iron supplementation was associated with a significantly lower risk of receiving a blood transfusion (OR = 0.54; 95% CI 0.40 to 0.75; p < 0.001). At the first postoperative day, the iron supplementation group had significantly higher mean hemoglobin levels compared to the no-treatment group (MD = 0.22 g.dL-1; 95% CI 0.02 to 0.42; p = 0.03). However, the pooled results could not rule out the null hypothesis for the difference in mean hemoglobin levels throughout the first week (MD = 0.12 g.dL-1; 95% CI -0.12 to 0.35; p = 0.34).
Conclusion
Preoperative intravenous iron supplementation in non-anemic patients undergoing major surgeries, particularly cardiac procedures, significantly reduces transfusion requirements. However, the benefits of oral iron remain uncertain, and further research is warranted to establish standardized perioperative supplementation protocols.
Keywords
Resumo
Introdução
As transfusões de sangue estão associadas a aumento de morbidade e mortalidade, e manter os estoques globais de sangue pode ser um desafio. Esta revisão sistemática investiga o impacto da suplementação pré-operatória de ferro sobre o risco de transfusão sanguínea em pacientes não anêmicos submetidos a cirurgias de grande porte.
Métodos
Realizamos uma busca sistemática nas bases PubMed, Embase e Cochrane Central para ensaios clínicos randomizados publicados até maio de 2024. Estudos que envolveram o uso de eritropoietina ou pacientes que já estavam utilizando suplementação de ferro no momento da randomização do estudo foram excluídos. Os desfechos avaliados incluíram o número de indivíduos que receberam transfusão de sangue e os níveis médios de hemoglobina no primeiro dia e na primeira semana pós-operatória.
Resultados
Um total de 1.162 pacientes não anêmicos de 9 estudos foi incluído. Desses, 54% receberam suplementação de ferro pré-operatória. A média de idade foi de 71 anos, e 44% eram mulheres. A suplementação de ferro pré-operatória foi associada a um risco significativamente menor de receber transfusão de sangue (OR = 0,54; IC 95% 0,40 a 0,75; p < 0,001). No primeiro dia pós-operatório, o grupo que recebeu suplementação de ferro teve níveis médios de hemoglobina significativamente mais altos em comparação ao grupo sem tratamento (MD = 0,22 g.dL⁻¹; IC 95% 0,02 a 0,42; p = 0,03). No entanto, os resultados agrupados não conseguiram excluir a hipótese nula para a diferença nos níveis médios de hemoglobina durante a primeira semana (MD = 0,12 g.dL⁻¹; IC 95% -0,12 a 0,35; p = 0,34).
Conclusão
A suplementação intravenosa de ferro pré-operatória em pacientes não anêmicos submetidos a cirurgias de grande porte, especialmente procedimentos cardíacos, reduz significativamente a necessidade de transfusão. No entanto, os benefícios do ferro oral permanecem incertos, e mais pesquisas são necessárias para estabelecer protocolos padronizados de suplementação perioperatória.
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References
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Submitted date:
11/26/2024
Accepted date:
03/09/2025
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