Center for Surgical Science (CSS), Department of Surgery, Zealand University Hospital & University of Copenhagen, Lykkebaekvej 1, 4600, Koege, Denmark.
World J Surg. 2019 Jul;43(7):1677-1691. doi: 10.1007/s00268-019-04971-7.
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.
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.
Of the 5413 studies screened, four randomized controlled trials and nine observational cohort studies were included. Ten studies included patients with hip fractures. A meta-analysis of seven studies showed a risk reduction of transfusion (OR = 0.35 CI 95% (0.20-0.63), p = 0.0004, I = 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.
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.
手术相关的围手术期贫血与不良临床结局相关。在择期手术中，可以通过术前补充铁剂来纠正贫血，从而优化患者状况。但在急性手术期间进行优化的选择有限。本综述旨在研究围手术期给予铁剂治疗是否能改善接受重大非心脏急性手术的患者的结局。
本系统综述通过 PubMed、EMBASE（Ovid）和 Scopus 检索了关于急性手术中铁剂补充的现有证据。主要结局是异体输血（ABT）率和血红蛋白变化。次要结局是术后死亡率、住院时间（LOS）和术后并发症。铁剂最晚在手术后 24 小时内给予。
在筛选的 5413 项研究中，纳入了四项随机对照试验和九项观察性队列研究。十项研究纳入了髋部骨折患者。对七项研究的荟萃分析显示，输血风险降低（OR=0.35，95%CI（0.20-0.63），p=0.0004，I²=66%）。对血浆血红蛋白没有影响。四项观察性研究的荟萃分析显示，铁剂治疗组的术后死亡率降低（OR 0.50，95%CI（0.26-0.96），p=0.04）。对 LOS 没有影响，但四项研究显示术后感染减少。
本综述检查了急性重大非心脏手术中的围手术期铁剂治疗。IV 铁剂显示出较低的 30 天死亡率、术后感染减少和 ABT 减少，这主要归因于观察性研究。本综述主要由小型观察性研究组成，没有足够的证据正式推荐这种治疗方法。
