LAUSR

To investigate the association between iron supplementation and blood transfusion risks, hospital length of stay, postoperative infection, and mortality in geriatric patients with hip fracture surgeries. Data from this meta-analysis suggest that iron supplementation, especially preoperative intravenous use of iron at 200–300 mg, is associated with a reduction in the rate and volume of blood transfusions, infections and length of hospital stay in older patients with hip fracture surgeries. These findings support the preoperative intravenous use of iron at 200–300 mg in older adults undergoing hip fracture surgeries. To assess the efficacy and safety of iron supplementation for perioperative anemia in geriatric patients with hip fracture. A systematic search was conducted for studies published using PubMed, EMBASE and Cochrane Library Databases that compared iron supplementation with placebo in patients undergoing hip fracture surgery. The outcomes were blood transfusion rate and volume, length of stay, infection and mortality (last follow-up). Sub-group and sensitivity analyses were performed in cases of substantial heterogeneity. The meta-analysis (6 studies: 1201 patients) indicated that iron supplements were not associated with reducing blood transfusion rate (OR 0.92, 95% CI 0.60–1.41; P = 0.69), but high heterogeneity (I2 = 61%) was detected and a significant association was found in sensitivity analysis of four studies (n = 637; OR 0.68, 95% CI 0.49–0.95; P = 0.02). A significant reduction was detected in transfusion volume (two studies: n = 234; MD − 0.45 units/patient, 95% CI − 0.74 to − 0.16; P = 0.002), hospital stay (five studies: n = 998; MD − 1.42, 95% CI − 2.18 to − 0.67; P = 0.0002) and caused no increased risk of mortality (five studies: n = 937; OR 0.94, 95% CI 0.65–1.36; P = 0.76) and infection (four studies: n = 701; OR 0.58, 95% CI 0.38–0.90; P = 0.01). Sub-group analyses of four studies showed that the preoperative intravenous use of iron at 200–300 mg (two studies) may be the beneficial option for hip fractures patients. Iron supplementation, especially preoperative intravenous use of 200–300 mg iron, is safe and associated with reducing transfusion requirement and hospital stay. Unfortunately, data were too limited to draw a definite conclusion. Further evaluation is required before recommending iron supplementation for older patients with hip fracture surgeries.