The Effect of Preoperative Intravenous Iron Supplementation on Mortality and Blood Transfusion Requirements in Elderly Patients Undergoing Hip Fracture Surgery: A Prospective Randomized Controlled Trial

Background/Objectives: 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. Methods: 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. Results: The FCM group demonstrated significantly lower mortality at both 6 months (22.9% vs. 39.0%, p = 0.011) and 12 months (28.4% vs. 42.9%, p = 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%, p = 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. Conclusions: 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.