Kizilkurt Taha, Ozkaya Mustafa, Balli Mert, Demirel Mehmet, Asik Mehmet
Department of Orthopaedics and Traumotology, Faculty of Medicine, Istanbul University, Çapa, 34093 Istanbul, Turkey.
J Clin Med. 2025 Jul 3;14(13):4713. doi: 10.3390/jcm14134713.
: Elderly patients who suffer a hip fracture often have a high risk of complications and mortality, which can be made worse by anemia during and after surgery. Although restrictive transfusion strategies are recommended, the role of preoperative intravenous iron, particularly ferric carboxymaltose (FCM), remains unclear. This study aimed to investigate whether preoperative IV FCM reduces mortality and transfusion requirements in geriatric hip fracture patients managed under a restrictive transfusion strategy. : A study was conducted in which 220 patients aged 65 years and over who had undergone surgery for a hip fracture were included. These patients were allocated to receive either a single 1000 mg dose of intravenous FCM approximately 12 h before surgery or no iron supplementation. All the patients were managed with a standardized restrictive transfusion strategy. The primary outcome was all-cause mortality at 6 and 12 months. The secondary outcomes included perioperative transfusion requirement, hemoglobin trends, and length of hospital stay. : The FCM group demonstrated significantly lower mortality at both 6 months (22.9% vs. 39.0%, = 0.011) and 12 months (28.4% vs. 42.9%, = 0.028) compared to the control group. Multivariate logistic regression identified preoperative FCM administration as one of the independent protective factors for mortality. The FCM group had significantly lower transfusion rates (30.9% vs. 45.5%, = 0.02). No significant difference was observed at the 6-week follow-up in terms of the higher discharge hemoglobin levels seen in the control group. The difference in hospital stay duration did not reach statistical significance. : Preoperative intravenous FCM administration could reduce both short- and long-term mortality and transfusion needs in geriatric hip fracture patients managed under a restrictive transfusion protocol. These findings support further investigation of high dose IV iron as a component of perioperative blood management in this high-risk population.
老年髋部骨折患者术后常伴有较高的并发症风险及死亡率，而手术期间及术后的贫血会使情况恶化。尽管推荐采用限制性输血策略，但术前静脉补铁，尤其是羧基麦芽糖铁（FCM）的作用仍不明确。本研究旨在探讨术前静脉注射FCM能否降低采用限制性输血策略管理的老年髋部骨折患者的死亡率及输血需求。
本研究纳入了220例65岁及以上接受髋部骨折手术的患者。这些患者被随机分为两组，一组在手术前约12小时接受单次1000mg静脉注射FCM，另一组不补充铁剂。所有患者均采用标准化的限制性输血策略。主要结局指标为6个月和12个月时的全因死亡率。次要结局指标包括围手术期输血需求、血红蛋白变化趋势及住院时间。
与对照组相比，FCM组在6个月（22.9% 对39.0%，P = 0.011）和12个月（28.4% 对42.9%，P = 0.028）时的死亡率均显著降低。多因素逻辑回归分析确定术前给予FCM是死亡率的独立保护因素之一。FCM组的输血率显著较低（30.9% 对45.5%，P = 0.02）。在6周随访时，对照组较高的出院血红蛋白水平差异无统计学意义。住院时间差异未达到统计学显著性。
术前静脉注射FCM可降低采用限制性输血方案管理的老年髋部骨折患者的短期和长期死亡率及输血需求。这些发现支持进一步研究高剂量静脉补铁作为这一高危人群围手术期血液管理的组成部分。
