Objective: To evaluate the effectiveness of routine intravenous iron in surgical patients with iron deficiency anemia (IDA). Background: Anemia is the most common medical disease in the world and is an independent risk factor for morbidity and mortality. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on surgical outcome. Methods: In this prospective single-center observational study, surgical patients were screened for the presence of anemia and ID. Patients were assigned to 1 of 4 study groups:anemia, iron-deficient, iron supplementation) according to hemoglobin level, iron status, and supplementation with iron. Results: Among 1728 patients, 1028 were assigned to A), a reduced intraoperative transfusion rate was observed for ID and IDA patients only if iron was supplemented >7 days before surgery. Hospital stay was significantly reduced by 2.8 days in ironsupplemented patients (P < 0.01 comparing 13.9 AE 0.8 days for A þ , ID þ , T þ vs. 16.7 AE 0.7 days for A þ ). Conclusion: Preoperative IDA management with intravenous iron is effective in improving hemoglobin level, thereby reducing intraoperative RBC transfusion rate particular if iron is administrated >7 days before surgery. Hospital length of stay was reduced in all preoperatively iron-supplemented IDA patients.

Lumbar disc herniation is rare in patients under the age of 20 years. In the department of orthopaedic surgery of the University Hospital of Frankfurt, 33 patients below the age of 20 with lumbar disc herniation were treated over a period of 10 years. Eighteen were managed conservatively and 15 surgically. The purpose of this study is to report on the long-term outcome of these patients and to compare the results of conservative and surgical treatment. We analysed information obtained from the medical records, and for the long-term follow-up we prepared a questionnaire. The questionnaire was composed of general questions about the patients' lifestyle and their ability to return to a normal life and activity after treatment, together with a request for them to score their pain level and remaining symptoms. We found that the longest duration of symptoms before diagnosis was 72 months, with a mean duration of 11.1 months. Low back pain and monoradicular sciatica were the main complaints, but findings of neurological deficits were rare. Lasegue's sign and tight hamstrings seemed to be strong diagnostic signs in this age group. On the day of discharge, 94% of patients reported excellent or good results. The outcomes after a mean follow-up period of 5.4 years were similar in both treatment groups. Almost all patients were able to attain a normal activity level and few reported restrictions on their daily life. Only 14% complained of permanent pain and 7% reported poor results regarding their activity capabilities. In conclusion, we believe that in all cases of lumbar disc herniation in the second decade of life, conservative treatment should be pursued as a mainstay of treatment. Only after a certain time, if conservative treatment is ineffective, should surgical treatment be considered.

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