Efficacy and safety of intravenous iron supplementation for perioperative iron deficiency anemia: a systematic review and network meta-analysis of randomized controlled trials.

OBJECTIVE

Anemia is common in the perioperative period, with approximately one-third of surgical patients presenting with preoperative anemia and even higher rates of anemia postoperatively due to blood loss. The comparative efficacy and safety of different intravenous iron preparations for perioperative anemia remain unclear. This study aims to evaluate their efficacy and safety by a comprehensive network meta-analysis (NMA).

METHODS

A systematic search of PubMed, Embase, and the Cochrane Library was conducted from inception to December 10, 2024, to identify randomized controlled trials (RCTs) involving intravenous iron administration in the perioperative period. Two independent researchers extracted and cross-checked the data. Outcomes included transfusion rate, hemoglobin (Hb) concentrations, adverse events, quality of life (QoL), hypersensitivity reactions, and hypophosphatemia. A Bayesian NMA was performed.

RESULTS

Thirty-four RCTs with a total of 4688 participants were included in the NMA. Ferric carboxymaltose (FCM, mean difference [MD] 0.76 g/dL, 95 % credible interval [CrI] 0.56 to 0.96) and iron isomaltoside (IIM, MD 0.65 g/dL, 95 % CrI 0.33 to 0.97) significantly increased Hb concentrations compared with placebo. However, only FCM reduced transfusion requirements (odds ratio [OR] 0.72, 95 % CrI 0.55 to 0.91). The safety analysis revealed no significant differences in adverse events between the groups. Descriptive analysis indicated improved QoL with FCM compared to placebo for fatigue and dyspnea (QLQ-C30) and physical functioning (SF-36). For NMA, no significant inconsistencies were found between direct and indirect evidence.

CONCLUSIONS

FCM improves perioperative Hb concentrations and reduces transfusion requirements. All intravenous iron preparations demonstrated acceptable safety profiles. Further research is needed to validate these findings and refine perioperative iron supplementation strategies.