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

Background: 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. Methods: 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. Results: = 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. Conclusion: 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.