Effectiveness and efficiency of pre-operative anaemia management with intravenous iron: a systematic review

Date

2012

Authors

Froessler, B.
Tufanaru, C.
Pearson, A.
Cyna, A.

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The JBI Database of Systematic Reviews and Implementation Reports, 2012; 10(Suppl. 14):S68-S78

Statement of Responsibility

Bernd Froessler, Catalin Tufanaru, Alan Pearson, Allan Cyna

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Abstract

Review objectives The quantitative objective is to identify the effectiveness of intravenous iron administration on the correction of iron deficiency anaemia in the perioperative setting. More specifically, the objectives are to identify the effectiveness of iron infusion on the rate of red blood cell (RBC) transfusion and incidence of transfusion related co morbidities such as postoperative infection, immunological morbidity and mortality. In addition changes in functional capacity that could impact on quality of life. The economic objective of this review is to identify the cost aspects of anaemia management. More specifically, the objectives are to identify the evidence of cost benefits on pre-operative anaemia correction and the potential for cost savings on blood products and the indirect cost savings on transfusion related adverse effects. Inclusion criteria Types of participants Both the quantitative component and the economic component of the review will consider studies that include adult patients presenting for major surgery, regardless of gender, ethnicity, diagnosis and co-morbidities with pre-operative anaemia. Types of intervention(s)/phenomena of interest The quantitative component of the review will consider studies that evaluate the management of anaemia with iron infusions compared to oral iron treatment alone, oral iron in combination with erythropoietin, erythropoietin alone or haemoglobin correction with blood transfusion. This will include the dosage of iron, the frequency of its administration and the time frame of treatment prior to surgery. In addition it is of interest to assess how the intervention was employed, the personnel involved and the time spent to complete management. The economic component of this review will consider studies that evaluate the costs and benefits (cost- effectiveness, cost-utility, or cost-benefit) of iron infusions compared to oral iron treatment or haemoglobin correction with blood transfusion for the treatment of pre-operative anaemia. Types of outcomes The quantitative component of this review will consider studies that include (but not limited to) the following outcome measures: • The effect of iron administration on haemoglobin levels • The rate of red blood cell (RBC) transfusion measured as proportion of patients transfused with allogeneic RBC and the average number of units transfused. • The length of stay in hospital • Rate of readmission within 30 days of discharge • The incidence of transfusion related co- morbidities measured as infection rates, the occurrence of transfusion related lung injury (TRALI), transfusion related circulatory overload (TACO) and the number of deaths. • The imReview objectives The quantitative objective is to identify the effectiveness of intravenous iron administration on the correction of iron deficiency anaemia in the perioperative setting. More specifically, the objectives are to identify the effectiveness of iron infusion on the rate of red blood cell (RBC) transfusion and incidence of transfusion related co morbidities such as postoperative infection, immunological morbidity and mortality. In addition changes in functional capacity that could impact on quality of life. The economic objective of this review is to identify the cost aspects of anaemia management. More specifically, the objectives are to identify the evidence of cost benefits on pre-operative anaemia correction and the potential for cost savings on blood products and the indirect cost savings on transfusion related adverse effects. Inclusion criteria Types of participants Both the quantitative component and the economic component of the review will consider studies that include adult patients presenting for major surgery, regardless of gender, ethnicity, diagnosis and co-morbidities with pre-operative anaemia. Types of intervention(s)/phenomena of interest The quantitative component of the review will consider studies that evaluate the management of anaemia with iron infusions compared to oral iron treatment alone, oral iron in combination with erythropoietin, erythropoietin alone or haemoglobin correction with blood transfusion. This will include the dosage of iron, the frequency of its administration and the time frame of treatment prior to surgery. In addition it is of interest to assess how the intervention was employed, the personnel involved and the time spent to complete management. The economic component of this review will consider studies that evaluate the costs and benefits (cost- effectiveness, cost-utility, or cost-benefit) of iron infusions compared to oral iron treatment or haemoglobin correction with blood transfusion for the treatment of pre-operative anaemia. Types of outcomes The quantitative component of this review will consider studies that include (but not limited to) the following outcome measures: • The effect of iron administration on haemoglobin levels • The rate of red blood cell (RBC) transfusion measured as proportion of patients transfused with allogeneic RBC and the average number of units transfused. pact of intravenous iron administration on functional outcomes The economic component of the review will consider (but not limited to) the following outcome measures: • the reduction in costs for units of allogeneic blood avoided • the reduction in cost associated with a reduction in length of stay in hospital LOS • the reduction in transfusion laboratory cost and nursing time • The increase in cost for iron administered and nursing time Types of studies The quantitative component of the review will consider any experimental study design including randomised controlled trials, non-randomised controlled trials, quasi-experimental, before and after studies for inclusion. The economic component of the review will consider cost effectiveness, cost-utility, and cost-benefit studies for inclusion.

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