Preoperative intravenous iron and red blood cell transfusion requirements in elderly intertrochanteric femoral fractures

Abstract Background Intravenous (IV) iron is used in patient blood management for elderly patients with hip fractures, but its effectiveness in reducing red blood cell (RBC) transfusion remains unclear. This study evaluated the effect of preoperative IV iron on perioperative RBC transfusion volume and identified associated factors. Methods We retrospectively reviewed 307 patients aged ≥65 years who underwent cephalomedullary nailing for intertrochanteric femoral fractures between 2018 and 2021. From November 2020, patients routinely received preoperative IV iron; earlier patients did not (180 non‐IV iron and 127 IV iron). Patient, fracture, surgical and transfusion variables were compared. Multiple regression identified factors associated with total perioperative transfusion volume. Results Total perioperative RBC transfusion volume did not differ between the non‐IV iron and IV iron groups (292.1 vs. 272.7 mL, p = 0.868). In multiple regression analysis, significant predictors were AO Foundation/Orthopaedic Trauma Association fracture classification ( β = 73.1 mL, 95% confidence interval [CI] 32.4–113.7, p < 0.001), spinal anaesthesia ( β = −78.9 mL, 95% CI −144.3 to −13.5, p = 0.018), operative time ( β = 2.9 mL/min, 95% CI 0.5–5.2, p = 0.020) and admission haemoglobin level ( β = −94.6 mL/g/dL, 95% CI −111.1 to −78.1, p < 0.001). Preoperative IV iron was not independently associated with transfusion volume ( β = −49.7 mL, 95% CI −103.1 to 3.7, p = 0.068). Conclusion Preoperative IV iron did not significantly reduce perioperative RBC transfusion requirements in elderly patients with intertrochanteric femoral fractures. Shorter operative time and spinal anaesthesia were associated with lower transfusion volume.