Association between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational study
Abstract 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. Thi...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-05-01
|
| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-021-02462-x |
| _version_ | 1797999449875677184 |
|---|---|
| author | Silas Zacharias Clemmensen Kristian H. Kragholm Dorte Melgaard Lene T. Hansen Johannes Riis Christian Cavallius Marianne M. Mørch Maria Lukács Krogager |
| author_facet | Silas Zacharias Clemmensen Kristian H. Kragholm Dorte Melgaard Lene T. Hansen Johannes Riis Christian Cavallius Marianne M. Mørch Maria Lukács Krogager |
| author_sort | Silas Zacharias Clemmensen |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-11T11:04:48Z |
| format | Article |
| id | doaj.art-0f26eaf3ba4540b1aaf6756d422a4f27 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T11:04:48Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-0f26eaf3ba4540b1aaf6756d422a4f272022-12-22T04:28:22ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2021-05-0116111010.1186/s13018-021-02462-xAssociation between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational studySilas Zacharias Clemmensen0Kristian H. Kragholm1Dorte Melgaard2Lene T. Hansen3Johannes Riis4Christian Cavallius5Marianne M. Mørch6Maria Lukács Krogager7Center for Clinical Research, North Denmark Regional HospitalCenter for Clinical Research, North Denmark Regional HospitalCenter for Clinical Research, North Denmark Regional HospitalDepartment of Geriatric Medicine, North Denmark Regional HospitalCenter for Clinical Research, North Denmark Regional HospitalDepartment of Orthopedic Surgery, Aalborg University HospitalDepartment of Geriatric Medicine, North Denmark Regional HospitalDepartment of Cardiology, Aalborg University HospitalAbstract 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.https://doi.org/10.1186/s13018-021-02462-xHip fracturesOlder peopleMortalityAnemiaIron |
| spellingShingle | Silas Zacharias Clemmensen Kristian H. Kragholm Dorte Melgaard Lene T. Hansen Johannes Riis Christian Cavallius Marianne M. Mørch Maria Lukács Krogager Association between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational study Journal of Orthopaedic Surgery and Research Hip fractures Older people Mortality Anemia Iron |
| title | Association between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational study |
| title_full | Association between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational study |
| title_fullStr | Association between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational study |
| title_full_unstemmed | Association between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational study |
| title_short | Association between intravenous iron therapy and short-term mortality risk in older patients undergoing hip fracture surgery: an observational study |
| title_sort | association between intravenous iron therapy and short term mortality risk in older patients undergoing hip fracture surgery an observational study |
| topic | Hip fractures Older people Mortality Anemia Iron |
| url | https://doi.org/10.1186/s13018-021-02462-x |
| work_keys_str_mv | AT silaszachariasclemmensen associationbetweenintravenousirontherapyandshorttermmortalityriskinolderpatientsundergoinghipfracturesurgeryanobservationalstudy AT kristianhkragholm associationbetweenintravenousirontherapyandshorttermmortalityriskinolderpatientsundergoinghipfracturesurgeryanobservationalstudy AT dortemelgaard associationbetweenintravenousirontherapyandshorttermmortalityriskinolderpatientsundergoinghipfracturesurgeryanobservationalstudy AT lenethansen associationbetweenintravenousirontherapyandshorttermmortalityriskinolderpatientsundergoinghipfracturesurgeryanobservationalstudy AT johannesriis associationbetweenintravenousirontherapyandshorttermmortalityriskinolderpatientsundergoinghipfracturesurgeryanobservationalstudy AT christiancavallius associationbetweenintravenousirontherapyandshorttermmortalityriskinolderpatientsundergoinghipfracturesurgeryanobservationalstudy AT mariannemmørch associationbetweenintravenousirontherapyandshorttermmortalityriskinolderpatientsundergoinghipfracturesurgeryanobservationalstudy AT marialukacskrogager associationbetweenintravenousirontherapyandshorttermmortalityriskinolderpatientsundergoinghipfracturesurgeryanobservationalstudy |