Allogeneic red blood cell transfusion is an independent risk factor for 1-year mortality in elderly patients undergoing femoral neck fracture surgery

Abstract

Allogeneic red blood cell transfusion (ABT) is 1 of the poor prognostic factors for morbidity and mortality in patients with hip fracture, particularly among elderly patients. This study aimed to investigate the risk factors for ABT and 1-year mortality in elderly patients undergoing surgery for femoral neck fracture. A total of 225 elderly patients who underwent femoral neck fracture surgery between May 2013 and November 2015 at a tertiary medical center were retrospectively recruited. Medical records were analyzed. The median patient age was 80 years and 28.4% were men. A total of 113 patients received ABT (50.2%). Multivariate logistic regression analysis showed that female sex (odds ratio [OR] 2.606, 95% confidence interval [CI] 1.283–5.295, P = .008), malignancy (OR 5.098, 95% CI 1.725–15.061, P = .003), chronic kidney disease stage ≥ 3 (OR 3.258, 95% CI 1.603–6.622, P = .001), and anemia (hemoglobin < 12 g/dL) (OR 4.684, 95% CI 2.230–9.837, P < .001) were significantly associated with ABT. The 1-year mortality rate after surgery was 15.1%. Male sex (OR 2.477, 95% CI 1.101–5.575, P = .028), ABT (OR 2.367, 95% CI 1.036–5.410, P = .041), and intensive care unit admission (OR 5.564, 95% CI 1.457–21.249, P = .012) were significantly associated with 1-year mortality. In this study, underlying comorbidities such as chronic kidney disease and malignancy were associated with ABT. Furthermore, ABT was a significant independent risk factor for 1-year mortality. These findings suggest that underlying comorbidities and the need for ABT should be considered in the risk assessment of elderly patients with femoral neck fracture to improve the outcomes after surgery.

Outcomes of the Anterior-Based Muscle-Sparing Approach in Elective Total Hip Arthroplasty in Nonagenarians

“…Though blood transfusion may be necessary in managing acute blood loss following surgery, it is not without its risks. For instance, blood transfusion following surgery for femoral neck fractures has been associated with an increased risk of infection and has been shown to be an independent risk factor for mortality at 1 year [ [24] , [25] , [26] ]. As such, efforts to avoid transfusion should be made.…”

Low lymphocyte-to-C-reactive protein ratio relates to high 1-year mortality in elderly patients undergoing hemiarthroplasty for displaced femoral neck facture

“…Among of them, the higher rate of transfusion deserves special mention. Previous studies have reported that allogeneic transfusion was a predictor for 1-year mortality in elderly patients with surgically treated FNF [ 30 ]. In addition, hypoalbuminemia and AAC ≥ 6 were also identified as independent risk factors ( P = 0.041, P = 0.040, respectively) for 1-year mortality in multivariate analysis, which was consistent with previous studies [ 8 , 13 ].…”

Allogeneic Red Blood Cell Transfusion Rate and Risk Factors After Hemiarthroplasty in Elderly Patients With Femoral Neck Fracture

“…Previous studies reported that blood transfusion increased the incidence of complications and led to blood shortages, prolonged hospital stays, and increased hospital costs ( Dai et al, 2020 ; Shin et al, 2020 ). For elderly FNF patients undergoing HA, these problems cannot be ignored.…”