• Chang-Hoon Koo, Hyun-Jung Shin, HyunHee Cho, and Jung-Hee Ryu.
• Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
• J. Surg. Res. 2020 Feb 1; 246: 42-51.

BackgroundPatient blood management aims to maintain hemoglobin level, minimize blood loss, and avoid unnecessary blood transfusion. Ferric carboxymaltose, an intravenous iron agent, was included as a part of surgical patient blood management strategy. However, it is still controversial that ferric carboxymaltose can reduce transfusion requirements. The purpose of this systematic review and meta-analysis is to evaluate the benefits of perioperative ferric carboxymaltose on the postoperative hematological parameters and transfusion requirements.MethodsRandomized controlled trials evaluating the effects of ferric carboxymaltose were searched through databases: MEDLINE, EMBASE, CENTRAL, CINAHL, Scopus, Web of Science, and KoreaMed. Meta-analysis was performed using random effect models.ResultsA total of 8 studies (n = 471) were included in the final analysis. Postoperative hemoglobin was higher in the ferric carboxymaltose group than in the control group (mean difference [MD], 0.58 g/dL; 95% confidence interval [CI], 0.36 to 0.80; P < 0.00001). Postoperative serum ferritin and transferrin saturation were also higher in the ferric carboxymaltose group (MD, 373.85 μg/L; 95% CI, 298.13 to 449.56; P < 0.00001; MD, 10.35%; 95% CI, 4.59 to 16.10; P < 0.00001, respectively). However, there were no significant differences in the number of transfused patients, length of hospital stay, and adverse events between groups. Subgroup analysis revealed that adverse events were lower in the ferric carboxymaltose group than the oral iron group.ConclusionsThis study supports that ferric carboxymaltose may increase the postoperative hemoglobin level in surgical patients. However, transfusion requirements could not be reduced by ferric carboxymaltose. Optimal dose and time should be further analyzed.Copyright © 2019 Elsevier Inc. All rights reserved.

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