Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients

Abstract

BackgroundAnemia is more often seen in older patients. As the mean age of hip fracture patients is rising, anemia is common in this population. Allogeneic blood transfusion (ABT) and anemia have been pointed out as possible risk factors for poorer outcome in hip fracture patients.MethodsIn the timeframe 2005-2010, 1262 admissions for surgical treatment of a hip fracture in patients aged 65 years and older were recorded. Registration was prospective from 2008 on. Anemic and non-anemic patients (based on hemoglobin level at admission) were compared regarding clinical characteristics, mortality, delirium incidence, LOS, discharge to a nursing home and the 90-day readmission rate. Receiving an ABT, age, gender, ASA classification, type of fracture and anesthesia were used as possible confounders in multivariable regression analysis.ResultsThe prevalence of anemia and the rate of ABT both were 42.5%. Anemic patients were more likely to be older and men and had more often a trochanteric fracture, a higher ASA score and received more often an ABT. In univariate analysis, the 3- and 12-month mortality rate, delirium incidence and discharge to a nursing home rate were significantly worse in preoperatively anemic patients.In multivariable regression analysis, anemia at admission was a significant risk factor for discharge to a nursing home and readmission < 90 days, but not for mortality. Indication for ABT, age and ASA classification were independent risk factors for mortality at all moments, only the mortality rate for the 3-12 month interval was not influenced by ABT. An indication for an ABT was the largest negative contributor to a longer LOS (OR 2.26, 95% CI 1.73-2.94) and the second largest for delirium (OR 1.67, 95% CI 1.28-2.20).ConclusionsThis study has demonstrated that anemia at admission and postoperative anemia needing an ABT (PANT) were independent risk factors for worse outcome in hip fracture patients. In multivariable regression analysis, anemia as such had no effect on mortality, due to a rescue effect of PANT. In-hospital, 3- and 12-month mortality was negatively affected by PANT, with the main effect in the first 3 months postoperatively.

Clinical Impact of Indirect Markers of Renal Function in Elderly Patients With Hip Fracture

“…In multivariate analysis, anemia was not a risk factor for mortality, but institutionalization and readmission were. 30 In our cohort, anemia, hematocrit, and transfusion requirements also appeared to be associated with increased mortality. However, in contrast to the study of Vochteloo et al, our multivariate analysis showed that neither hemoglobin nor blood transfusion requirements were independent risk factors for death, unlike the HUGE value that proved to be an independent predictor of mortality.…”

A systematic review of pre-operative anaemia and blood transfusion in patients with fractured hips

“…5). This result was unaffected by which mortality rate we included from rates reported at different time points by two studies [22,40]. Four other studies reported statistically significant associations between pre-operative anaemia and mortality that we could not include in the meta-analysis [16,30,34,37].…”

“…Anaemia on admission was associated with increased mortality [17,18,20,22,25,27,28,33,36,40] at all time points beyond 30 days (Fig. 3), whether the anaemia was mild (Fig.…”

“…Four other studies reported statistically significant associations between pre-operative anaemia and mortality that we could not include in the meta-analysis [16,30,34,37]. The data for hospital length of stay, reported by seven studies, were unsuitable for meta-analysis [19,20,22,27,29,40,41]. Six studies found no association between admission anaemia and length of stay [19,20,22,29,40,41] and one reported that anaemia was associated with increased stays [27].…”

“…The data for hospital length of stay, reported by seven studies, were unsuitable for meta-analysis [19,20,22,27,29,40,41]. Six studies found no association between admission anaemia and length of stay [19,20,22,29,40,41] and one reported that anaemia was associated with increased stays [27]. Readmission to hospital was associated with anaemia in one study, up to 90 days after discharge [40], but anaemia was not associated with readmission up to 28 days after discharge in a second study [35].…”