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Role of parenteral iron in the management of anaemia in the elderly patient undergoing displaced subcapital hip fracture repair: preliminary data

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Abstract

Introduction

An important percentage of patients affected by hip fracture require the administration of allogenic blood transfusion (ABT) to avoid the risks of perioperative acute anaemia. However, concerns about ABT risks have led to the search for alternatives, especially in elective orthopaedic surgery.

Materials and methods

We have prospectively investigated the effect of preoperative intravenous 200–300 mg (group 2; n=20) iron sucrose on ABT requirements and postoperative morbid-mortality in patients undergoing surgery for displaced subcapital hip fracture (DSHF) repair. A previous series of 57 DSHF patients served as the control group (group 1). All patients were older than 65 years, were operated on the 3rd day after admission to the hospital, by the same medical team, and using the same implant. Age, gender, ASA classification, surgical procedure, perioperative haemoglobin, requirements for ABT, postoperative infection, length of hospital stay (LOS) and 30-day mortality rate were examined.

Results

No adverse reactions to the iron administration were observed. The iron group had a lower transfusion rate (15% vs 36.8%), lower transfusion index (0.26 vs 0.77 units per patient), lower 30d mortality rate (0 vs 19.3%), shorter LOS (11.9 vs 14.1 days), as well as a trend to a lower postoperative infection rate (15% vs 33%).

Conclusion

Preoperative parenteral iron administration could be a safe and effective way to reduce the ABT requirements in DSHF patients. This reduction in the ABT requirements is accompanied by a reduction in the morbid-mortality rate and LOS. A large, randomised, controlled trial to confirm these results is warranted.

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Acknowledgement

We gratefully acknowledge the manuscript reviewing by Dr. J.H. Palmer (Department of Anaesthesiology, Clínica Santa Elena, Torremolinos, Spain).

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, ‘Miguel Servet’ University Hospital, Zaragoza, Spain

    Jorge Cuenca & Angel A. Martínez

  2. Department of Haematogy and Haemotherapy, ‘Miguel Servet’ University Hospital, Zaragoza, Spain

    José Antonio García-Erce

  3. Department of Preventive Medicine, ‘Miguel Servet’ University Hospital, Zaragoza, Spain

    Víctor M. Solano

  4. Department of Orthopaedic and Trauma Surgery, Hospital of Barbastro, Huesca, Spain

    Juan Molina

  5. GIEMSA, School of Medicine, University of Málaga, Campus de Teatinos, 29071, Málaga, Spain

    Manuel Muñoz

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  1. Jorge Cuenca
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  2. José Antonio García-Erce
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  3. Angel A. Martínez
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  4. Víctor M. Solano
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  5. Juan Molina
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  6. Manuel Muñoz
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Correspondence to Manuel Muñoz.

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Cuenca, J., García-Erce, J.A., Martínez, A.A. et al. Role of parenteral iron in the management of anaemia in the elderly patient undergoing displaced subcapital hip fracture repair: preliminary data. Arch Orthop Trauma Surg 125, 342–347 (2005). https://doi.org/10.1007/s00402-005-0809-3

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  • DOI: https://doi.org/10.1007/s00402-005-0809-3

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