Liu Chang, Han Jiashu, Fu Renkui, Li Tianyu, Margonis Georgios Antonios, Wang Jaeyun Jane, Ma Kaiqi, Wang Weibin, Lin Chen
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
EClinicalMedicine. 2025 Jul 17;86:103361. doi: 10.1016/j.eclinm.2025.103361. eCollection 2025 Aug.
Anaemia complicates recovery in surgical patients. Intravenous (IV) iron supplementation shows promise in improving outcomes, but optimal timing remains uncertain. In this review, we compare the efficacy, safety, tolerability, and outcomes between preoperative and postoperative IV iron supplementation.
In this systematic review and network meta-analysis, we searched PubMed, EMBASE, Cochrane Library, and Web of Science from inception to May 1, 2025, for randomised controlled trials (RCT) investigating IV iron supplementation in surgical patients either 7-30 days before surgery (preoperative) or 0-30 days after surgery (postoperative). Studies were excluded if they included patients with critical illness or prior transfusion or if iron was given outside the defined time frames or with other agents. Two reviewers independently appraised the data and extracted summary estimates from published reports. The primary outcomes were: (1) proportion of patients who received blood transfusion; (2) change between the baseline haemoglobin level and the haemoglobin level on postoperative day (POD) 7 and POD30. Data processing was conducted based on frequentist network meta-analysis. The risk of bias was assessed using the Cochrane Risk of Bias tool. The protocol is registered with PROSPERO, CRD42024533265.
Among 129 identified studies, 22 RCTs with 3026 patients were included. All included studies had a low (n = 6) or moderate (n = 16) risk of bias. Compared to controls, postoperative IV iron supplementation reduced transfusion rates (RR 0.80, 95% CI 0.68-0.94; I = 0.0%). Postoperative IV iron supplementation did not affect haemoglobin levels (MD -4.51, 95% CI -9.75 to 0.72; I = 90.3%) at POD7 but increased haemoglobin levels (MD 5.45, 95% CI 2.70-8.20; I = 45.5%) at POD30. In comparison, preoperative IV iron supplementation resulted in higher haemoglobin levels than postoperative supplementation at POD30 (MD 6.67, 95% CI 1.61-11.72) but did not influence transfusion rates (RR 0.91, 95% CI 0.72-1.15; I = 0.0%).
Our results suggest that postoperative IV iron supplementation reduces transfusion rates, while preoperative supplementation improves haemoglobin recovery. Clinicians may choose either strategy in an individualised, patient-centered manner. These conclusions should be interpreted with caution due to heterogeneity among included studies, limited data for subgroup analyses, and the absence of direct comparisons between preoperative and postoperative approaches.
National Key Research and Development Program of China, National Natural Science Foundation of China, Beijing Natural Science Foundation, Capital's Funds for Health Improvement and Research, National High Level Hospital Clinical Research Funding, and Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences.
贫血会使外科手术患者的康复过程复杂化。静脉注射铁剂补充剂在改善治疗效果方面显示出前景，但最佳给药时机仍不确定。在本综述中，我们比较术前和术后静脉注射铁剂补充剂在疗效、安全性、耐受性及治疗结果方面的差异。
在这项系统评价和网状Meta分析中，我们检索了从数据库建立至2025年5月1日的PubMed、EMBASE、Cochrane图书馆和Web of Science，以查找关于外科手术患者在术前7至30天或术后0至30天进行静脉注射铁剂补充剂的随机对照试验（RCT）。如果研究纳入了危重症患者或既往有输血史的患者，或者铁剂在规定时间范围之外给药或与其他药物联合使用，则将其排除。两名研究者独立评估数据，并从已发表的报告中提取汇总估计值。主要结局为：（1）接受输血的患者比例；（2）基线血红蛋白水平与术后第7天（POD7）和第30天（POD30）血红蛋白水平的变化。数据处理基于频率学派网状Meta分析进行。使用Cochrane偏倚风险工具评估偏倚风险。该方案已在PROSPERO注册，注册号为CRD42024533265。
在129项已识别的研究中，纳入了22项RCT，共3026例患者。所有纳入研究的偏倚风险均较低（n = 6）或中等（n = 16）。与对照组相比，术后静脉注射铁剂补充剂可降低输血率（RR 0.80，95%CI 0.68 - 0.94；I² = 0.0%）。术后静脉注射铁剂补充剂在POD7时对血红蛋白水平无影响（MD -4.51，95%CI -9.75至0.72；I² = 90.3%），但在POD30时可提高血红蛋白水平（MD 5.45，95%CI 2.70 - 8.20；I² = 45.5%）。相比之下，术前静脉注射铁剂补充剂在POD30时导致的血红蛋白水平高于术后补充（MD 6.67，95%CI 1.61 - 11.72），但对输血率无影响（RR 0.91，95%CI 0.72 - 1.15；I² = 0.0%）。
我们的结果表明，术后静脉注射铁剂补充剂可降低输血率，而术前补充可改善血红蛋白恢复情况。临床医生可以以个体化、以患者为中心的方式选择任一策略。由于纳入研究之间存在异质性、亚组分析数据有限以及术前和术后方法之间缺乏直接比较，这些结论应谨慎解读。
国家重点研发计划、国家自然科学基金、北京市自然科学基金、首都健康改善与研究专项基金、国家高水平医院临床研究专项基金以及中国医学科学院医学与健康科技创新工程。
