Anemia at Presentation Predicts Acute Mortality and Need for Readmission Following Geriatric Hip Fracture

Abstract

Background: There is a paucity of research regarding the relationship between anemia and postoperative morbidity and mortality among geriatric patients presenting with hip fracture. The objective of this study was to determine the effect of anemia at presentation on 30-day morbidity and mortality among geriatric patients with hip fracture. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all hip fracture patients ≥60 years old from 2011 to 2016. Included were all emergency unilateral, nonpathological hip fractures (femoral neck, intertrochanteric, or subtrochanteric) treated with arthroplasty, intramedullary nailing, or open reduction and internal fixation. Anemia was classified as a hematocrit (HCT) level of <0.41 and <0.36 for male and female patients, respectively. Age, body mass index (BMI), race, comorbidities, smoking status, American Society of Anesthesiologists (ASA) class, baseline functional status, time to surgery, operative time, anesthesia type, need for transfusion, fixation method, length of stay (LOS), and discharge destination were collected. Our primary outcome of interest was 30-day postoperative mortality, with all-cause readmission and any postoperative ischemic events (cerebrovascular accident [CVA] and myocardial infarction [MI]) analyzed as secondary outcomes. A multivariable regression analysis was performed and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated while controlling for confounding variables. Results: Of 34,805 patients identified, 22,469 (65%) were anemic at presentation (63% female; mean age, 80 ± 8 years), while 12,336 (35%) were non-anemic (85% female; mean age, 79 ± 8 years). Anemia at presentation was independently associated with higher odds of mortality (OR,1.3 [95% CI, 1.1 to 1.5]) and readmission (OR, 1.2 [95% CI, 1.1 to 1.3]), while no relationship was observed for MI (OR, 1.1 [95% CI, 0.9 to 1.4]) or CVA (OR, 0.8 [95% CI, 0.6 to 1.1]). Conclusions: Our findings suggest that anemia at presentation is associated with greater 30-day postoperative morbidity and mortality in geriatric hip fracture patients. Additional research should focus on elucidating this modifiable risk factor and advancing the preoperative optimization of hip fracture patients. Level of Evidence: Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Prognostic Factors for Mortality, Activity of Daily Living, and Quality of Life in Taiwanese Older Patients within 1 Year Following Hip Fracture Surgery

“…Multiple clinical parameters have been proposed as predictors for postoperative ADL recovery, including age, sex, surgical delay, preinjury status, [31][32][33] preoperative hemoglobin values, renal function, and handgrip strength [34,35]. In the present study, nine clinical variables were identified to be independently associated with postoperative BI in the GEE univariate analysis.…”

Hematopoiesis, Inflammation and Aging—The Biological Background and Clinical Impact of Anemia and Increased C-Reactive Protein Levels on Elderly Individuals

“…This study also observed an increased mortality associated with anemia. Finally, a large study investigated the association between anemia at presentation and postoperative mortality for elderly patients with a mean age of 79.2 years [167]. At presentation, 65% of these patients were anemic, and anemia was then associated with an increased odds ratio for mortality (1.3/p = 0.004); there was no significant association between anemia and myocardial infarction or cerebrovascular events.…”

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

“…Anaemia progresses significantly during the days before surgery, more so in extracapsular fractures. In hip fracture patients, anaemia has been associated with increased risk of blood transfusion, poorer functional outcomes and increased mortality [ 102 ]. Hip fracture surgery is additionally associated with perioperative blood loss frequently requiring transfusion.…”