# Effects of erythropoietin administration on allogeneic blood transfusion requirements in adults undergoing surgery: a systematic review and meta-analysis

## TL;DR

This study finds that giving erythropoietin before surgery reduces the need for blood transfusions without increasing risks like infections or hospital stays.

## Contribution

The study provides updated meta-analysis evidence on erythropoietin's effect on transfusion requirements across various surgical types.

## Key findings

- Erythropoietin reduces transfusion rates and transfusion volumes in surgical patients.
- No significant effects on mortality, infections, or hospital stay were observed.
- Subgroup analyses confirm reduced transfusion needs across multiple surgery types.

## Abstract

Erythropoietin is commonly integrated into blood management strategies for surgical patients, yet its administration may lead to adverse outcomes. This systematic review and meta-analysis assesses the impact of erythropoietin administration on perioperative transfusion requirements and adverse events.

A comprehensive search across four databases was conducted from inception to 30 July 2025 to identify randomized controlled trials involving adult surgical patients. The methodological quality of the included studies was evaluated using the Cochrane Risk of Bias Assessment Tool. The outcome measures included transfusion rates, volume of allogeneic red blood cell transfusions per patient unit, mortality rates, postoperative infection rates, transfusion-related complications, venous thromboembolism rates, and length of hospital stay. Effect sizes were reported using relative risk (RR) and standardized mean difference (SMD). We used GRADE to assess the quality of evidence for each outcome.

Preoperative erythropoietin administration reduces transfusion rates (RR = 0.63, 95% CI = 0.53–0.75, p = 0.000) and mean transfusion volumes (SMD = −0.33, 95% CI = −0.42 to −0.24, p = 0.000) in surgical patients. No significant impact was observed on mortality, postoperative infection incidence, postoperative complications, adverse reactions, venous thromboembolic events, and length of hospital stay. Subgroup analyses showed significant reductions in transfusion rates for cardiac surgery, orthopedic surgery, gastrointestinal surgery, gynecological abdominal surgery, and other types of surgery.

The available evidence supports the efficacy of preoperative human erythropoietin administration in reducing transfusion requirements and the average number of transfusion units in adult surgical patients. No significant differences were observed in postoperative mortality, complication rate, adverse event rate, venous thromboembolic events (including deep vein thrombosis and pulmonary embolism), and hospital stay after preoperative administration of erythropoietin.