Low haemoglobin at admission is associated with mortality after hip fractures in elderly patients

Abstract

Aims Low haemoglobin (Hb) at admission has been identified as a risk factor for mortality for elderly patients with hip fractures in some studies. However, this remains controversial. This study aims to analyze the association between Hb level at admission and mortality in elderly patients with hip fracture undergoing surgery. Patients and Methods All consecutive patients (prospective database) admitted with hip fracture operated in a tertiary hospital between 2012 and 2016 were analyzed. We collected patient characteristics, time to surgery, duration and type of surgery, comorbidities, Hb at admission, nadir of Hb after surgery, the use and amount of red blood cells (RBCs) transfusion products, postoperative complications, and death. The main outcome measures were mortality at 30 days, 90 days, 180 days, and one year after surgery. Results We included 829 patients; the mean age was 81 years (sd 11). Mortality at 30 days, 90 days, 180 days, and one year was 5.7%, 12.3%, 18.1%, and 23.5%, respectively. The highest mortality was observed in patients aged over 80 years (162/557, 29%) and in male patients (85/267, 32%). Survival at 90 days, 180 days, and one year after surgery was significantly lower in patients with a Hb level below 120 g/l at admission. In multivariate analysis, Hb level below 120 g/l at admission was found to be an independent factor associated with mortality (adjusted hazard ratio (aHR) 1.68 (95% confidence interval (CI) 1.22 to 2.31); p = 0.001), along with age (aHR 1.06 (95% CI 1.04 to 1.06); p < 0.001), male sex (aHR 2.19 (95% CI 1.61 to 2.96); p < 0.001), and need for RBC transfusions (aHR 1.10 (95% CI 1.02 to 1.19); p = 0.01). Conclusion Our results suggest that low Hb at admission along with age and RBC transfusions is significantly associated with short- and long-term mortality after hip fracture surgery, independently of comorbidity confounders. Further studies should be performed to understand how preoperative Hb could be taken into account in perioperative management. Cite this article: Bone Joint J 2019;101-B:1122–1128.

Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study

“…In this study, the overall mortality at 30 days, 1 year and total mortality at last follow-up were 4.5, 9.0 and 18.6%, which were lower than that in other countries [ 5 , 6 ]. A recent systematic analysis calculated the 1-year mortality rate after hip fracture in mainland China, and the estimated mortality was 13.96% (95% CI: 12.26–15.86%) [ 34 ].…”

Oral Supplementation with Sucrosomial Ferric Pyrophosphate Plus L-Ascorbic Acid to Ameliorate the Martial Status: A Randomized Controlled Trial

“…In Orthopedics, about 17.5% of all subjects undergoing elective hip or knee replacement present iron-deficiency anemia [3], 20%-30% have uncharacterized anemia [3,4], and over 50% may require preoperative blood transfusions [5], with trauma patients possibly presenting higher rates. Regardless of etiology, anemia conditions are associated with wound complications, readmissions, higher transfusions, and mortality rates [3,[6][7][8][9]. The lower cytochrome activity grounds altered bactericidal activity of leucocytes [10][11][12][13] and can impair the patient's immune response.…”

Orthogeriatric Care: Reviewing Improvements in Outcomes

“…Patients receiving postoperative transfusions had a significantly higher risk-adjusted 30-day mortality, total hospital length of stay and readmission rates. Survival at 90 days, 180 days, and one year after surgery was significantly lower among patients with a Hb level below 12 g/dL at admission [104].…”