Shah Akshay, Palmer Antony J R, Fisher Sheila A, Rahman Shah M, Brunskill Susan, Doree Carolyn, Reid Jack, Sugavanam Anita, Stanworth Simon J
1Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Level 4 Academic Block, Oxford, OX3 9DU UK.
2Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Perioper Med (Lond). 2018 Dec 12;7:30. doi: 10.1186/s13741-018-0109-4. eCollection 2018.
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, = 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, = 37%). IV iron did not reduce the risk of requiring a blood transfusion (RR 0.90, 95% CI 0.73 to 1.11, = 0.46, = 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).
静脉注射铁剂治疗贫血的指南主要关注择期手术患者，而很少关注接受非择期/急诊手术的患者。虽然这些患者可能因其当前疾病而预后不良，但观察数据表明，未经治疗的贫血也可能是导致不良预后的一个因素。我们进行了一项系统评价，以研究静脉注射铁剂在接受非择期手术患者中的安全性和有效性。
我们遵循预先定义的评价方案，纳入接受静脉注射铁剂的非择期手术患者的随机对照试验（RCT）。主要结局是全因感染和随访时血红蛋白（Hb）的平均差异。次要结局包括输血需求、住院时间（LOS）、健康相关生活质量（HRQoL）、死亡率和不良事件。
本系统评价纳入了3项RCT（605名参与者），其中两项针对髋部骨折（HF）患者的RCT提供了荟萃分析数据。这两项RCT的偏倚风险均较低。我们没有发现感染风险存在差异的证据（风险比0.99，95%置信区间0.55至1.80，P = 9%），也没有发现“短期”（≤7天）随访时Hb浓度存在差异的证据（平均差异-0.32 g/L，95%置信区间-3.28至2.64，P = 37%）。静脉注射铁剂并未降低输血需求风险（风险比0.90，95%置信区间0.73至1.11，P = 0.46，I² = 0%），我们也未观察到死亡率、住院时间或不良事件存在差异。一项RCT报告了HRQoL情况，发现各治疗组之间没有差异。
我们没有确凿证据表明静脉注射铁剂对接受非择期手术患者的临床重要结局有影响。有必要进行进一步有足够效力的试验，以评估其在贫血负担较重的急诊外科专科中的益处。
本系统评价已在PROSPERO（CRD42018096288）上注册。
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