title: Role of parenteral iron in the management of anaemia in the elderly patient undergoing displaced subcapital hip fracture repair: preliminary data.
abstract: BACKGROUND
  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.
  
  
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, 'Miguel Servet' University Hospital, Zaragoza, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Cuenca
authors.forename: José Antonio
authors.initials: JA
authors.lastname: García-Erce
authors.forename: Angel A
authors.initials: AA
authors.lastname: Martínez
authors.forename: Víctor M
authors.initials: VM
authors.lastname: Solano
authors.forename: Juan
authors.initials: J
authors.lastname: Molina
authors.forename: Manuel
authors.initials: M
authors.lastname: Muñoz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D019644:Arthroplasty, Replacement, Hip; D001803:Blood Transfusion; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage*; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid; D006397:Hematinics / Q000008:administration & dosage*; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies
chemical_list: D005290:Ferric Compounds; D006397:Hematinics; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid