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Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery

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 pre...

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Autores principales: Yoon, Byung-Ho, Lee, Beom Seok, Won, Heejae, Kim, Hyung-Kook, Lee, Young-Kyun, Koo, Kyung-Hoi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Orthopaedic Association 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695329/
https://www.ncbi.nlm.nih.gov/pubmed/31475045
http://dx.doi.org/10.4055/cios.2019.11.3.265
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author Yoon, Byung-Ho
Lee, Beom Seok
Won, Heejae
Kim, Hyung-Kook
Lee, Young-Kyun
Koo, Kyung-Hoi
author_facet Yoon, Byung-Ho
Lee, Beom Seok
Won, Heejae
Kim, Hyung-Kook
Lee, Young-Kyun
Koo, Kyung-Hoi
author_sort Yoon, Byung-Ho
collection PubMed
description 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.
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spelling pubmed-66953292019-09-01 Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery Yoon, Byung-Ho Lee, Beom Seok Won, Heejae Kim, Hyung-Kook Lee, Young-Kyun Koo, Kyung-Hoi Clin Orthop Surg Original Article 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. The Korean Orthopaedic Association 2019-09 2019-08-12 /pmc/articles/PMC6695329/ /pubmed/31475045 http://dx.doi.org/10.4055/cios.2019.11.3.265 Text en Copyright © 2019 by The Korean Orthopaedic Association http://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Yoon, Byung-Ho
Lee, Beom Seok
Won, Heejae
Kim, Hyung-Kook
Lee, Young-Kyun
Koo, Kyung-Hoi
Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery
title Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery
title_full Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery
title_fullStr Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery
title_full_unstemmed Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery
title_short Preoperative Iron Supplementation and Restrictive Transfusion Strategy in Hip Fracture Surgery
title_sort preoperative iron supplementation and restrictive transfusion strategy in hip fracture surgery
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695329/
https://www.ncbi.nlm.nih.gov/pubmed/31475045
http://dx.doi.org/10.4055/cios.2019.11.3.265
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