A nationwide study of blood transfusion in hip fracture patients

Farrow, Luke; Brasnic, L; Martin, Christine; Ward, Kirsty; Adam, Karen; Hall, Andrew J.; Clement, Nick D; MacLullich, Alasdair M.J.

doi:10.1302/0301-620x.104b11.bjj-2022-0450.r1

Cited by 16 publications

(6 citation statements)

References 31 publications

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“…14 Further, anaemia is a major independent risk factor for adverse perioperative outcomes, and this includes an association with increased mortality. 26 Some studies have reported a higher blood loss when inserting IMNs compared to SHSs. 27,28 Furthermore, patients who received blood transfusion and were treated with IMN received more units of blood compared to those treated with SHS.…”

Section: Discussionmentioning

confidence: 99%

Equivalent mortality after operation with sliding hip screw or intramedullary nail for trochanteric AO/OTA A1 and A2 fractures reported in the Norwegian Hip Fracture Register 2008 to 2020

Ahmad,

Egeland,

Dybvik

et al. 2024

Bone Joint J

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AimsThis study aimed to compare mortality in trochanteric AO/OTA A1 and A2 fractures treated with an intramedullary nail (IMN) or sliding hip screw (SHS). The primary endpoint was 30-day mortality, with secondary endpoints at 0 to 1, 2 to 7, 8 to 30, 90, and 365 days.MethodsWe analyzed data from 26,393 patients with trochanteric AO/OTA A1 and A2 fractures treated with IMNs (n = 9,095) or SHSs (n = 17,298) in the Norwegian Hip Fracture Register (January 2008 to December 2020). Exclusions were made for patients aged < 60 years, pathological fractures, pre-2008 operations, contralateral hip fractures, fractures other than trochanteric A1/A2, and treatments other than IMNs or SHSs. Kaplan-Meier and Cox regression analyses adjusted for type of fracture, age, sex, cognitive impairment, American Society of Anesthesiologists (ASA) grade, and time period were conducted, along with calculations for number needed to harm (NNH).ResultsIn unadjusted analyses, there was no significant difference between IMN and SHS patient survival at 30 days (91.8% vs 91.1%; p = 0.083) or 90 days (85.4% vs 84.5%; p = 0.065), but higher one-year survival for IMNs (74.5% vs 73.3%; p = 0.031) compared with SHSs. After adjustments, no significant difference in 30-day mortality was found (hazard rate ratio (HRR) 0.94 (95% confidence interval (CI) 0.86 to 1.02(; p = 0.146). IMNs exhibited higher mortality at 0 to 1 days (HRR 1.63 (95% CI 1.13 to 2.34); p = 0.009) compared with SHSs, with a NNH of 556, but lower mortality at 8 to 30 days (HRR 0.89 (95% CI 0.80 to 1.00); p = 0.043). No differences were observed in mortality at 2 to 7 days (HRR 0.94 (95% CI 0.79 to 1.11); p = 0.434), 90 days (HRR 0.95 (95% CI 0.89 to 1.02); p = 0.177), or 365 days (HRR 0.97 (95% CI 0.92 to 1.02); p = 0.192).ConclusionThis study found no difference in 30-day mortality between IMNs and SHSs. However, IMNs were associated with a higher mortality at 0 to 1 days and a marginally lower mortality at 8 to 30 days compared with SHSs. The observed differences in mortality were small and should probably not guide choice of treatment.Cite this article: Bone Joint J 2024;106-B(6):603–612.

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Section: Discussionmentioning

confidence: 99%

Equivalent mortality after operation with sliding hip screw or intramedullary nail for trochanteric AO/OTA A1 and A2 fractures reported in the Norwegian Hip Fracture Register 2008 to 2020

Ahmad,

Egeland,

Dybvik

et al. 2024

Bone Joint J

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“…Socioeconomic deprivation was associated with an increased risk of not returning home, which has been shown to increase the risk of post‐discharge morbidity and readmission to acute services (Kay, Hall, et al., 2022). Extracapsular hip fracture patterns were also associated with an increased risk of not returning home when controlling for confounding factors; one potential explanation is increased perioperative and intraoperative blood loss, as well as an increased risk of blood transfusion (Farrow et al., 2022; Johnston et al., 2010). Return to home living is an important outcome for patients and services alike because failure to do so represents a significant loss of personal independence and a much greater burden on health and social care resources.…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 is associated with increased care needs and a decreased likelihood of returning home following a hip fracture: The IMPACT frailty study

Hall

Clement

Kay

et al. 2023

Musculoskeletal Care

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PurposeThe primary aim was to evaluate the impact of COVID‐19 on frailty in patients surviving a hip fracture. Secondary aims were to assess impact of COVID‐19 on (i) length of stay (LoS) and post‐discharge care needs, (ii) readmissions, and (iii) likelihood of returning to own home.MethodsThis propensity score‐matched case‐control study was conducted in a single centre between 01/03/20–30/11/21. A ‘COVID‐positive’ group of 68 patients was matched to 141 ‘COVID‐negative’ patients. ‘Index’ and ‘current’ Clinical Frailty Scale (CFS) scores were assigned for frailty at admission and at follow‐up. Data were extracted from validated records and included: demographics, injury factors, COVID‐19 status, delirium status, discharge destination, and readmissions. For subgroup analysis controlling for vaccination availability, the periods 1 March 2020–30 November 2020 and 1 February 2021–30 November 2021 were considered pre‐/post‐vaccine periods.ResultsMedian age was 83.0 years, 155/209 (74.2%) were female and median follow‐up was 479 days (interquartile range [IQR] 311). There was an equivalent median increase in CFS in both groups (+1.00 [IQR 1.00–2.00, p = 0.472]). However, adjusted analysis demonstrated COVID‐19 was independently associated with a greater magnitude change (Beta coefficient [β] 0.27, 95% confidence interval [95% CI] 0.00–0.54, p = 0.05). COVID‐19 in the post‐vaccine availability period was associated with a smaller increase versus pre‐vaccine (β −0.64, 95% CI −1.20 to −0.09, p = 0.023). COVID‐19 was independently associated with increased acute LoS (β 4.40, 95% CI 0.22–8.58, p = 0.039), total LoS (β 32.87, 95% CI 21.42–44.33, p < 0.001), readmissions (β 0.71, 95% CI 0.04–1.38, p = 0.039), and a four‐fold increased likelihood of pre‐fracture home‐dwelling patients failing to return home (odds ratio 4.52, 95% CI 2.08–10.34, p < 0.001).ConclusionsHip fracture patients that survived a COVID‐19 infection had increased frailty, longer LoS, more readmissions, and higher care needs. The health and social care burden is likely to be higher than prior to the COVID‐19 pandemic. These findings should inform prognostication, discharge‐planning, and service design to meet the needs of these patients.

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“…[29][30][31] Blood transfusion, which is another common treatment choice, may theoretically improve the prognosis of hip fracture patients by correcting anemia. 32 However, studies have shown that transfusion did not reverse the harms of perioperative anemia in elderly hip fracture patients, and it is associated with poor outcomes such as subsequent infection, fluid overload, prolonged hospital stays, and increased mortality. [33][34][35] Given the shortage of blood supply, restrictive transfusion (70-90 g/L) may be a viable alternative that can reduce transfusion rates by 39-43% compared to unrestricted transfusion (90-110 g/L) and does not increase risk of complications such as myocardial infarction or mortality.…”

Section: Clinical Implicationmentioning

confidence: 99%

Preoperative Anemia and Risk of In-hospital Postoperative Complications in Patients with Hip Fracture

Yu¹,

Lin²,

Wang³

et al. 2023

CIA

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Purpose To evaluate the impact of preoperative anemia on postoperative complications after hip fracture surgery. Patients and Methods We conducted a retrospective study including hip fracture patients at a teaching hospital between 2005 and 2022. We defined preoperative anemia as the last hemoglobin measurement level before surgery < 130 g/L for men and < 120 g/L for women. The primary outcome was a composite of in-hospital major complications, including pneumonia, respiratory failure, gastrointestinal bleeding, urinary tract infection, incision infection, deep venous thrombosis, pulmonary embolism, angina pectoris, arrhythmia, myocardial infarction, heart failure, stroke, and death. Secondary outcomes were cardiovascular events, infection, pneumonia, and death. We used multivariate negative binomial or logistic regression to evaluate the impact of anemia and its severity, categorized as mild (90–130 g/L for men, 90–120 g/L for women) or moderate-to-severe (< 90 g/L for both) anemia on outcomes. Results Of the 3540 included patients, 1960 had preoperative anemia. 188 anemic patients experienced 324 major complications, while 63 non-anemic patients had 94 major complications. The risk of major complications was 165.3 (95% CI, 149.5–182.4) and 59.5 (95% CI, 48.9–72.3) per 1000 persons in anemic and non-anemic patients, respectively. Anemic patients were more likely to have major complications than non-anemic patients (adjusted incidence rate ratio (aIRR), 1.87; 95% CI, 1.30–2.72), which was consistent in mild (aIRR, 1.77; 95% CI, 1.22–2.59) and moderate-to-severe (aIRR, 2.97; 95% CI, 1.65–5.38) anemia. Preoperative anemia also increased the risk of cardiovascular events (aIRR, 1.96; 95% CI, 1.29–3.01), infection (aIRR, 1.68; 95% CI, 1.01–2.86), pneumonia (adjusted odds ratio (aOR), 1.91; 95% CI, 1.06–3.57), and death (aOR, 3.17; 95% CI, 1.06–11.89). Conclusion Our findings suggest that even mild preoperative anemia is associated with major postoperative complications in hip fracture patients. This finding highlights considering preoperative anemia as a risk factor in surgical decision-making for high-risk patients.

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A nationwide study of blood transfusion in hip fracture patients

Cited by 16 publications

References 31 publications

Equivalent mortality after operation with sliding hip screw or intramedullary nail for trochanteric AO/OTA A1 and A2 fractures reported in the Norwegian Hip Fracture Register 2008 to 2020

Equivalent mortality after operation with sliding hip screw or intramedullary nail for trochanteric AO/OTA A1 and A2 fractures reported in the Norwegian Hip Fracture Register 2008 to 2020

COVID‐19 is associated with increased care needs and a decreased likelihood of returning home following a hip fracture: The IMPACT frailty study

Preoperative Anemia and Risk of In-hospital Postoperative Complications in Patients with Hip Fracture

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