Original ArticleThe Impact of Perioperative Iron on the Use of Red Blood Cell Transfusions in Gastrointestinal Surgery: A Systematic Review and Meta-Analysis
Section snippets
Search Strategy
We systematically searched Medline (1966 to May 2013), EMBASE (1974 to May 2013), the Cochrane Register for Controlled Trials, Web of Knowledge (Web of Science and BIOSIS), and the Scopus database (1966 to May 2013), without restrictions regarding language or type of publication. We also searched the gray literature through OpenSIGLE, Intute (until closing in July 2011), the Trip database, and Google Scholar, as of May 2013. With assistance from an information specialist, the search strategy
Systematic Search
The initial electronic and gray literature search identified 878 citations, excluding duplicates, from which we selected 8 studies for full-text review (Fig 1). Among those, 4 studies were excluded: 1 narrative review [23], 1 with no details provided on the comparison group [24], 1 not reporting on transfusion outcomes [25], and 1 without available full-text format [26]. Interrater agreement on study selection was high. No additional citation was identified from meetings' proceedings or review
Discussion
We systematically reviewed data from 4 comparative studies investigating the association between perioperative iron supplementation and the need for allogeneic RBCT [27], [28], [29], [30]. Although our search considered all elective GI surgeries, all studies meeting inclusion criteria pertained to elective CRC surgery [27], [28], [29], [30]. A trend toward fewer patients requiring RBCT with perioperative iron supplementation was observed but did not reach statistical significance (RR, 0.66
Conclusion
In our study, we observed a nonsignificant trend toward a lower proportion of patients requiring RBCTs with the use of perioperative iron supplementation for CRC surgery. Current studies supporting the use of perioperative iron supplementation for CRC surgery are limited by heterogeneous interventions, small sample size, patient selection not based on anemia status, and use of surrogate outcomes. Therefore, there is insufficient evidence to support the routine use of perioperative iron to
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Funding: No external funding was received for this study.