Timing of intravenous iron for treatment of anaemia in surgical patients: a systematic review and network meta-analysis

作者：Chang Liu, Jiashu Han, Rongfeng Fu, Tianyu Li, Georgios Antonios Margonis, Jane Wang, Kaiqi Ma, Weibin Wang, Lin Chen · 发表于：EClinicalMedicine · 年份：2025 · DOI：10.1016/j.eclinm.2025.103361 · 被引用次数：7 · 研究领域：Blood transfusion and management、Iron Metabolism and Disorders、Erythropoietin and Anemia Treatment

Background 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. Methods 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. Findings 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 c...