Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery

Yoon, Byung‐Ho; Lee, Beom Seok; Won, Heejae; Kim, Hyung Kook; Lee, Yong Seuk; Koo, Kyung Hoi

doi:10.4055/cios.2019.11.3.265

Cited by 22 publications

(27 citation statements)

References 30 publications

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“…Preoperative iron supplementation combined with restrictive transfusion strategy (Hb level threshold ≤ 8 g/dL or symptoms) was compared with a liberal transfusion strategy (Hb level threshold ≤ 10 g/dL) without iron supplementation during hospitalization for hip fracture in a retrospective cohort study. The restrictive transfusion strategy was associated with a reduction in packed RBC units used per patient, but more transfusions in rehabilitation settings [ 111 ].…”

Section: Perioperative Carementioning

confidence: 99%

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

Tarazona-Santabalbina

Ojeda-Thies

Rodríguez

et al. 2021

IJERPH

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Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

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Section: Perioperative Carementioning

confidence: 99%

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

Tarazona-Santabalbina

Ojeda-Thies

Rodríguez

et al. 2021

IJERPH

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“…The elderly are more likely to have preoperative anemia due to multiple diseases, reduced absorption and utilization of hematopoietic materials, and reduced hematopoietic reserves. Yoon BH et al [16] believed that intravenous iron supplementation with restrictive blood transfusion is safe and effective for elderly patients with hip fractures.…”

Section: The Univariate Analysismentioning

confidence: 99%

Allogeneic Red Blood Cell Transfusion Rate and Risk Factors in Elderly Patients with Femoral Neck Fracture After Hemiarthroplasty

Yue¹,

Yang²,

Deng³

et al. 2021

Preprint

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Objective: To determine the rate and risk factors of allogeneic red blood cell transfusions (ABT) in elderly patients with femoral neck fracture (FNF) after hemiarthroplasty (HA). Methods: We conducted a study on elderly patients (≥65 years old) who were admitted to the geriatric trauma orthopedics ward of Beijing Jishuitan Hospital for HA treatment from March 2018 to February 2019 due to FNF. The perioperative data were collected retrospectively, and univariate and multivariate stepwise logistic regression analysis were performed to determine the postoperative ABT rate and its risk factors. Results: 445 patients were included in the study, of which 177 (39.8%) received ABT after surgery. Multivariate stepwise logistic regression analysis showed that preoperative low hemoglobin (Hb), high intraoperative blood loss (IBL), advanced age, and low body mass index (BMI) are independent risk factors of ABT after HA in elderly FNF patients. Conclusion: ABT after HA is a common phenomenon in elderly patients with FNF. Their postoperative ABT needs are related to preoperative low Hb, high IBL, advanced age, and low BMI. Therefore, ABT can be reduced from the above aspects.

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“…Besides heavy expense, ABT causes a higher risk of postoperative bacterial infections because of a immunological suppression, thus extending the hospitalization [10][11][12]. The alternative to ABT is stimulation of erythropoiesis with erythropoietin (EPO) and iron which seems to be associated with improved patient outcomes, reduced blood product utilization, reduced mortality, and product-related cost savings [13][14][15][16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Association between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational study

et al. 2021

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Background Anemia is common among ortho-geriatric hip fracture patients and is associated with prolonged recovery and increased postoperative mortality rate. Intravenous iron seems to increase hemoglobin recovery and reduce the mortality rate in patients undergoing orthopedic surgeries. This study investigated the association between short-term mortality risk and intravenous iron therapy in older patients undergoing hip fracture surgery. Methods This observational study included 210 patients undergoing hip fracture surgery from July 2018 to May 2020. These 210 patients were alive and had a hemoglobin ≤ 6.5 mmol/L on the 3rd postoperative day. In May 2019, a local intravenous iron therapy protocol was implemented and recommended intravenous iron (Monofer©) if hemoglobin on the 3rd postoperative day was ≤ 6.5 mmol/L. According to the treatment of postoperative anemia between the 1st and 3rd day post-surgery, the patients were divided into four groups: no treatment (n=52), blood transfusion (n=38), IV Monofer (n=80), and blood transfusion and IV Monofer (n=40). Primary outcome was 30-day mortality post-surgery. The secondary outcome was the impact on hemoglobin level 14–30 days postoperatively. Multivariable Cox regression was used to estimate the 30-day mortality standardized for covariates. Results Of 210 patients, 17 (8.1%) died within 30 days after surgery. There was a significantly lower mortality among the patients who received IV Monofer compared to those who received no treatment (HR 0.17, 95% CI [0.03–0.93], P = 0.041). Among the 86 patients with available hemoglobin measurements within 14 to 30 days post-surgery, there was no significant difference in hemoglobin level between the various treatment groups (mean 6.6 mmol/L, P = 0.1165). Conclusion IV Monofer on the 3rd postoperative day in older hip fracture patients seemed to reduce 30-day mortality compared with no treatment. No significant differences in hemoglobin levels between 14 and 30 days post-surgery across treatment groups were found, although this was assessed in a subset of patients with available hemoglobin levels warranting further study.

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Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery

Cited by 22 publications

References 30 publications

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

Allogeneic Red Blood Cell Transfusion Rate and Risk Factors in Elderly Patients with Femoral Neck Fracture After Hemiarthroplasty

Association between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational study

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