Scrimshire, Ashley orcid.org/0000-0002-7784-5891, Booth, Alison orcid.org/0000-0001-7138-6295, Fairhurst, Caroline Marie orcid.org/0000-0003-0547-462X et al. (3 more authors) (2020) Preoperative iron treatment in anaemic patients undergoing elective total hip or knee arthroplasty:a systematic review and meta-analysis. BMJ Open. e036592. ISSN 2044-6055
Abstract
Objectives: Preoperative anaemia is associated with increased risks of postoperative complications, blood transfusion and mortality. This meta-analysis aims to review the best available evidence on the clinical effectiveness of preoperative iron in anaemic patients undergoing elective total hip (THR) or total knee replacement (TKR). Design: Electronic databases and handsearching were used to identify randomised and non-randomised studies of interventions (NRSI) reporting perioperative blood transfusion rates for anaemic participants receiving iron before elective THR or TKR. Searches of CENTRAL, MEDLINE, Embase, PubMed and other databases were conducted on 17 April 2019 and updated on 15 July 2020. Two investigators independently reviewed studies for eligibility and evaluated risk of bias using the Cochrane risk of bias tool for randomised controlled trials (RCTs) and a modified Newcastle-Ottawa scale for NRSIs. Data extraction was performed by ABS and checked by AB. Meta-analysis used the Mantel-Haenszel method and random-effects models. Results: 807 records were identified: 12 studies met the inclusion criteria, of which 10 were eligible for meta- analyses (one RCT and nine NRSIs). Five of the NRSIs were of high-quality while there were some concerns of bias in the RCT. Meta-analysis of 10 studies (n=2178 participants) showed a 39% reduction in risk of receiving a perioperative blood transfusion with iron compared with no iron (risk ratio 0.61, 95% CI 0.50 to 0.73, p<0.001, I2=0%). There was a significant reduction in the number of red blood cell units transfused with iron compared with no iron (mean difference −0.37units, 95% CI −0.47 to 2-0.27, p<0.001, I =40%); six studies (n=1496). Length of stay was significantly reduced with iron, by an average of 2.08 days (95% CI −2.64 to −1.51, p<0.001, I2=40%); five studies (n=1140). Conclusions: Preoperative iron in anaemic, elective THR or TKR patients, significantly reduces the number of patients and number of units transfused and length of stay. However, high-quality, randomised trials are lacking. PROSPERO registration number CRD42019129035.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Author(s) (or their employer(s)) 2020. |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Sciences (York) > Health Sciences (York) |
Funding Information: | Funder Grant number NORTHUMBRIA HEALTHCARE NHS TRUST None |
Depositing User: | Pure (York) |
Date Deposited: | 04 Nov 2020 10:20 |
Last Modified: | 02 Dec 2024 01:13 |
Published Version: | https://doi.org/10.1136/bmjopen-2019-036592 |
Status: | Published |
Refereed: | Yes |
Identification Number: | 10.1136/bmjopen-2019-036592 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:167595 |
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