Clin Orthop Surg.  2019 Sep;11(3):265-269. 10.4055/cios.2019.11.3.265.

Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery

Affiliations
  • 1Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 2Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea. ykleemd@gmail.com

Abstract

BACKGROUND
Hip fracture surgery (HFS) is often associated with perioperative blood loss, and it frequently necessitates transfusion. However, the hemoglobin (Hb) threshold for transfusion remains controversial in hip fracture patients. We evaluated the usefulness of the restrictive strategy and preoperative intravenous iron supplementation in HFS.
METHODS
We retrospectively reviewed the medical records of 1,634 patients (> 60 years of age) who underwent HFS between May 2003 and June 2014 and were followed up for 1 year or more after surgery. We used the liberal transfusion strategy until May 2009 to determine the transfusion threshold; afterwards, we switched to the restrictive transfusion strategy. Patients with the restrictive transfusion strategy (restrictive group) received intravenous iron supplementation before surgery. We compared the transfusion rate, morbidity, and mortality of the restrictive group with those of the patients with the liberal transfusion strategy (liberal group).
RESULTS
Preoperative intravenous iron supplementation was not associated with any adverse reactions. The transfusion rate was 65.3% (506/775) in the liberal group and 48.2% (414/859) in the restrictive group (p < 0.001). The mean hospital stay was shorter in the restrictive group (21.5 vs. 28.8 days, p < 0.001). There was no significant difference in the postoperative medical complications including myocardial infarction and cerebrovascular event. Mortality at postoperative 30, 60, and 90 days was similar between the two groups.
CONCLUSIONS
Our blood management protocol involving restrictive strategy combined with preoperative intravenous iron supplementation appears to be effective and safe in HFS of elderly patients.

Keyword

Hip fractures; Iron; Allogeneic blood transfusion; Mortality; Complication

MeSH Terms

Aged
Hip Fractures
Hip*
Humans
Iron*
Length of Stay
Medical Records
Mortality
Myocardial Infarction
Retrospective Studies
Iron
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