Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery
10.4055/cios.2019.11.3.265
- Author:
Byung Ho YOON
1
;
Beom Seok LEE
;
Heejae WON
;
Hyung Kook KIM
;
Young Kyun LEE
;
Kyung Hoi KOO
Author Information
1. Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Hip fractures;
Iron;
Allogeneic blood transfusion;
Mortality;
Complication
- MeSH:
Aged;
Hip Fractures;
Hip;
Humans;
Iron;
Length of Stay;
Medical Records;
Mortality;
Myocardial Infarction;
Retrospective Studies
- From:Clinics in Orthopedic Surgery
2019;11(3):265-269
- CountryRepublic of Korea
- Language:English
-
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.
