Preoperative Hemoglobin <10 g/DL Predicts an Increase in Major Adverse Cardiac Events in Patients With Hip Fracture Over 80 Years: A Retrospective Cohort Study

Abstract

Background Preoperative anemia has been associated with perioperative morbidity and mortality in patients undergoing cardiac and non-cardiac surgery. Preoperative anemia is common in elderly hip fracture patients. The primary objective of the study was to explore the relationship between preoperative hemoglobin levels and postoperative major adverse cardiovascular events (MACEs) in hip fracture patients over 80 years. Methods The retrospective study enrolled hip fracture patients over 80 years from January 2015 to December 2021 in our center. The data were collected from the hospital’s electronic database after approval by the ethics committee. The primary objective of the study was to investigate MACEs, and the secondary objectives included in-hospital mortality, delirium, acute renal failure, ICU admission rate, and transfusion (&gt;2 U). Results 912 patients were entered for final analysis. Based on the restricted cubic spline, the risk of preoperative hemoglobin (&lt;10 g/DL) was associated with an increased risk of postoperative complications. With univariable logistic analysis, a hemoglobin level &lt;10 g/DL was associated with increased MACEs [OR 1.769, 95% CI (1.074, 2.914), P = .025], in-hospital mortality [OR 2.709, 95% CI (1.215, 6.039), P = .015] and transfusion &gt;2 U risk [OR 2.049, 95% CI (1.56, 2.69), P &lt; .001]. Even after adjustment for confounding factors, MACEs [OR 1.790, 95% CI (1.073, 2.985), P = .026], in-hospital mortality [OR 2.81, 95% CI (1.214, 6.514), P = .016] and transfusion &gt;2 U rate [OR 2.002, 95% CI (1.516, 2.65), P &lt; .001] were still higher in the lower hemoglobin level cohort. Moreover, a log-rank test showed increased in-hospital mortality in the cohort with a preoperative hemoglobin level of &lt;10 g/DL. However, there was no difference in delirium, acute renal failure, and ICU admission rates. Conclusions In conclusion, for hip fracture patients over 80 years, preoperative hemoglobin levels &lt;10 g/DL might be associated with increased postoperative MACEs, in-hospital mortality, and transfusion &gt;2 U.

Increasing serum miR-409-3p predicts the major adverse cardiac adverse events in elderly patients after hip fracture surgery

“…On the one hand, perioperative pain, blood loss, and massive fluid rehydration enhance cardiac load and increase cardiac susceptibility. On the other hand, based on the original cardiac dysfunction of elderly patients, cardiac decompensation is more likely to occur [ 25 , 26 ]. In addition, kidney dysfunction also increases cardiac load resulting in changes in the left atrium and ventricles and therefore induces the cardiac system [ 27 , 28 ].…”