Preoperative Correction of Low Hemoglobin Levels Can Reduce 1-Year All-Cause Mortality in Osteoporotic Hip Fracture Patients: A Retrospective Observational Study

Manosroi, Worapaka; Atthakomol, Pichitchai; Isaradech, Natthanaphop; Phinyo, Phichayut; Vaseenon, Tanawat

doi:10.2147/cia.s354519

Cited by 14 publications

(11 citation statements)

References 36 publications

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“…Some studies have reported some of management measures can reduce 1-year all-cause mortality in hip fracture patients. Our studies also have similar results [ 25 ]. From the results, we learned that the integrated management bundle made a significant survival benefit on the survival curve of super elderly hip fracture patients.…”

Section: Discussionsupporting

confidence: 88%

“…Blood management measures include correction of preoperative low hemoglobin levels. Worapaka Manosroi et.al reported preoperative correction of low hemoglobin levels can reduce 1-year all-cause mortality in hip fracture patients [ 25 ]. They believed that this was related to an increase of the oxygen-carrying capacity of blood.…”

Section: Discussionmentioning

confidence: 99%

“…The potential prognostic factors comorbidities, ASA score, type of fracture, treatment factors (type of treatment, type of anesthesia, admission delay), and laboratory investigations (hemoglobin concentration at admission) [9,[25][26][27][28].…”

Section: Potential Prognostic Factorsmentioning

confidence: 99%

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Effect of integrated management bundle on 1-year overall survival outcomes and perioperative outcomes in super elderly patients aged 90 and over with hip fracture: non-concurrent cohort study

Guo

Zhang

et al. 2022

BMC Musculoskelet Disord

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Background Due to concomitant factors like frailty and comorbidity, super elderly (≥90 years) patients with hip fracture differ from patients aged 65–89 years in perioperative complications and mortality. The integrated management bundle referred to bundled application of multiple clinical measures. The aim of this study was to analyze effect of integrated management bundle on 1-year overall survival and perioperative outcomes in super elderly patients with hip fracture, with multidisciplinary management group serving as the control group. Methods In this retrospective cohort study, super elderly patients with hip fracture were included from Jan 2017 to Nov 2020. Patients were retrospectively divided to multidisciplinary management group and integrated management bundle group. The primary outcome was 1- year overall survival, and the secondary outcome was perioperative outcomes. Kaplan-Meier methods was used to compare survival probability. Multivariable Cox’s modeling was used to explain the effect of integrated bundle on 1-year overall survival adjusted for confounders. The perioperative outcomes including complications and in-hospital data of two groups were compared. The multivariable logistic regression was used to explain the effect of integrated bundle on the occurrence of perioperative complications adjusted for confounders. Prognostic factors related to survival was identified by multivariable Cox’s regression analysis. Results Ninety-seven patients comprised multidisciplinary management group, and 83 comprised integrated management bundle group. The Kaplan–Meier plots showed that the survival probability of integrated management bundle group was significantly better than multidisciplinary management group (HR:0.435, 95%CI:0.207–0.914, P = 0.039). Multivariable analysis after adjustment for confounders showed a 42.8% lower incidence of mortality integrated management bundle group than multidisciplinary management group (HR:0.428, 95%CI:0.186–0.986, P = 0.046). Incidence of hypoproteinemia, and electrolyte disturbance in integrated management bundle group was significantly lower than multidisciplinary management group (all P < 0.05). In addition, significant reduction was observed in length of stay (P < 0.05) in integrated management bundle group. Multivariable logistic regression showed integrated management bundle was independent protective factor of hypoproteinemia, and electrolyte disturbance. mECM score ≥ 6 and ASA score > 2 were independent risk factors of overall survival (HR: 1.940, 95%CI: 1.067–3.525,P = 0.030; HR: 2.281, 95%CI: 1.113–4.678,P = 0.024). Conclusions The integrated management bundle improved 1-year overall survival and played positive effects in improving perioperative outcomes. It might be a more suitable management modality for super elderly patients with hip fracture.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Effect of integrated management bundle on 1-year overall survival outcomes and perioperative outcomes in super elderly patients aged 90 and over with hip fracture: non-concurrent cohort study

Guo

Zhang

et al. 2022

BMC Musculoskelet Disord

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“…A longitudinal analysis in old adults without anemia showed that higher hemoglobin levels were linked with better physical performance 16 . One observational study found that in patients with hip fracture, preoperative hemoglobin levels ≥ 10 g/dl lead to a 50% decreased risk of mortality compared to patients with hemoglobin levels < 10 g/dl (hazard ration(HR) = 0.50, 95% CI 0.25–0.99, P = 0.048) 17 . Another research investigated the outcomes in patients with chronic kidney disease under cardiac surgery and indicated that with 1 g/dl decrement in hemoglobin, the values of OR in mortality, sepsis, cerebrovascular complication and postoperative hemodialysis were 1.38(95%CI 1.23–1.57; P = 0.001), 1.31 (95%CI 1.14–1.49; P = 0.001), 1.31 (95%CI 1.00–1.67; P = 0.030), and 1.38 (95%CI 1.11–1.75; P = 0.010), respectively 18 .…”

Section: Discussionmentioning

confidence: 99%

Association between admission hemoglobin level and prognosis in sepsis patients based on a critical care database

Peng,

Su,

Luo

et al. 2024

Sci Rep

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This study aimed to explore the association between admission hemoglobin level and clinical outcomes in sepsis based on Medical Information Mart for Intensive Care IV(MIMIC-IV) database. It was a retrospective study. Sepsis patients in the database were included. Data extraction from MIMIC-IV was performed by PostgreSQL 9.6 software. Three different models including crude model (adjusted for none), model I (adjusted for gender and age) and model II (adjusted for all potential cofounders) were constructed. A generalized liner model and a smooth fitting curve for indicating the relationship between hemoglobin level and 30-day mortality were performed. 6249 septic patients with a 30.18% of 30-day mortality were included. With 1 g/dl increment in hemoglobin level, the values of odds ratio (OR) in crude model, model I and model II were 0.96 (95% confidential interval (CI) 0.94–0.99, P = 0.0023), 0.96 (95%CI 0.93–0.98, P = 0.0010) and 0.87 (95%CI 0.79–0.95, P = 0.0020), respectively. The smooth fitting curve indicated a non-linear relationship and the turning point was 7.2 g/dl. Compared the hemoglobin group < 7.2 g/dl, the risk of 30-day mortality significantly decreased by 32% in the hemoglobin group ≥ 7.2 g/dl (OR = 0.68, 95%CI 0.51–0.93, P = 0.0142). The non-linear relationship between admission hemoglobin level and 30-day mortality in sepsis was found. Hemoglobin supplementation might be beneficial for septic patients with hemoglobin level < 7.2 g/dl.

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“…Ascertaining the precise amount of hemoglobin loss during hospitalization poses a challenge. Consequently, it is not possible to directly assess the relationship between postoperative hemoglobin levels and the likelihood of death 17 . In contrast to previous research suggesting that the hemoglobin (Hb) level at admission is a signi cant independent predictor of postoperative mortality in elderly patients with hip fracture 18 , our study used Delta hemoglobin to evaluate the amount of hemoglobin loss during hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Percentage change in hemoglobin is closely linked to the one-year mortality rate in elderly patients who have suffered hip fractures

Zhou

Huang

Zhu³

et al. 2023

Preprint

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Purpose The objective of this study was to examine the relationship between the percentage change in hemoglobin (ΔHb) and 1-year mortality among patients who underwent hip fracture surgery. Percentage ΔHb was defined as: ([preoperative Hb - nadir Hb]/preoperative Hb) × 100. Methods A total of 636 patients with hip (including femoral neck and intertrochanteric femur) fractures who were hospitalised at an orthopaedic centre in China from January 2016 to December 2020 were reviewed as study subjects. General data were collected from patients, who underwent internal fixation or artificial femoral head replacement, and patients were followed up in outpatient clinics and by telephone for 1 year after surgery. The clinical value of predicting patient death was analysed using subject work characteristics (ROC) curve analysis, and multifactorial cox regression analysis was used to explore the influencing factors of death in elderly hip fracture patients at 1 year postoperatively. Results Over the course of the year following surgery, 108 patients (17.0%) passed away. The study found that a ΔHb value of 28.1% was the optimal cutoff for predicting mortality, with a sensitivity of 67.6% and specificity of 74.1%. Patients who had higher ΔHb levels had a significantly higher mortality rate (34.8% vs. 8.2%, p 0.001), and after adjusting for other factors, high ΔHb remained an independent predictor for one-year all-cause mortality (HR 4.12, 95% CI 2.66–6.39, p 0.001). Other independent risk factors for survival included advanced age, Charlson comorbidity index (CCI) >2, Blood transfusion, low albumin level, and longer length of stay. Additionally, the findings from subgroup analysis were generally in agreement with the main results across most stratified groups. Conclusions The percentage change in hemoglobin levels was found to be independently linked to the risk of mortality within one year. These outcomes indicate that utilizing percentage ΔHb as a metric could aid in identifying patients who are at a heightened risk for 1-year mortality.

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Preoperative Correction of Low Hemoglobin Levels Can Reduce 1-Year All-Cause Mortality in Osteoporotic Hip Fracture Patients: A Retrospective Observational Study

Cited by 14 publications

References 36 publications

Effect of integrated management bundle on 1-year overall survival outcomes and perioperative outcomes in super elderly patients aged 90 and over with hip fracture: non-concurrent cohort study

Effect of integrated management bundle on 1-year overall survival outcomes and perioperative outcomes in super elderly patients aged 90 and over with hip fracture: non-concurrent cohort study

Association between admission hemoglobin level and prognosis in sepsis patients based on a critical care database

Percentage change in hemoglobin is closely linked to the one-year mortality rate in elderly patients who have suffered hip fractures

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