Intravenous iron for perioperative anemia: recent advances, practical considerations, and future directions

Perioperative anemia is common in surgical patients and is associated with increased morbidity, mortality, prolonged hospitalization, and higher rates of allogeneic red blood cell transfusion. Iron deficiency, either absolute or functional, represents the leading underlying cause.

Recent advances in patient blood management emphasize early diagnosis and targeted treatment of anemia, with iron supplementation as a cornerstone intervention. This review summarizes current evidence on mechanisms, indications, and clinical outcomes of perioperative iron therapy, with a focus on oral and intravenous formulations across the perioperative pathway. Intravenous iron is particularly effective in the preoperative setting, especially when time to surgery is limited or inflammation is present, leading to increased hemoglobin levels and reduced transfusion requirements. Oral iron remains an option in mild cases when sufficient time is available. Postoperative iron supplementation may support recovery from anemia, although evidence for patient-centered outcomes remains limited.

Perioperative iron therapy is an essential, evidence-based strategy to optimize hemoglobin levels, reduce transfusion needs, and improve surgical outcomes.