The relationship between anemia at admission and outcome in patients older than 60 years with hip fracture

Abstract

Background We have reported that the functional outcome in elderly with hip fracture is related to age at admission, dementia, and anemia. In this study, we examined the relationship between hemoglobin level at admission and walking ability, as well as survival outcome at discharge. Materials and methods We studied 394 patients aged 60 years or older treated at our hospital for hip fracture since 1997. Anemia was defined as an admission hemoglobin level\13.0 g/dl for men and\12.0 g/dl for women. The relationships between anemia status with age at admission, gender, fracture type, residence before injury, walking ability at discharge, length of hospital stay, and survival outcome were analyzed. Results Anemia was observed in 266 of 394 patients. Univariate analysis identified no relationship between the status of anemia and age, gender, walking ability before injury, treatment modality, or length of hospital stay. On the other hand, 106 of 266 patients in the anemic group were residing in institutions, and as many as 72.9% of patients in the anemic group had trochanteric fracture. For walking ability at discharge, 92 of 128 patients without anemia were ambulatory compared with only 130 of 266 patients with anemia, with a significant difference between the two groups. Furthermore, there were 15 in-hospital deaths in the anemic group compared with one death in the nonanemic group. Multivariate analysis identified three independent items: age, fracture type, and walking ability at discharge, as related to the status of anemia. Conclusions Hemoglobin level at admission is related to outcome in patients with hip fracture.

Is anemia at admission related to short-term outcomes of elderly hip fracture patients?

“…In contrast to our findings, Hagino et al [17], who compared the outcome of patients with mild and severe anemia, reported no significant difference in ambulatory status at discharge between the two groups of patients. The study of Hagino et al [17] did not exclude patients who were non-ambulatory prior to fracture as well as patients treated non-operatively. The potential confounding effect of the heterogeneous nature of the population group [17] needs to be taken into account when comparing the results of this study.…”

“…Anemic patients in our study revealed to sustain more often an intertrochanteric fracture, which is consistent with the findings of previous studies [15,17]. The reason for this could possibly be explained in two ways.…”

“…Our results are consistent with other investigators. Hagino et al [17] reported that hemoglobin level at admission, as an indicator of the general status of the patient before injury, is a predictor of ambulation status at discharge. Contrary with above mentioned, in the study of Halm et al [16], who used a modified version of the locomotion subscale of FIM to access ambulation 60 days after hospital discharge no association between admission hemoglobin level and functional ability was found.…”

“…The study of Hagino et al [17] did not exclude patients who were non-ambulatory prior to fracture as well as patients treated non-operatively. The potential confounding effect of the heterogeneous nature of the population group [17] needs to be taken into account when comparing the results of this study. Our results imply that that the capacity of functional recovery is independently related to the degree of anemia.…”

“…The effect of perioperative anemia on surgical mortality and morbidity in hip fracture patients has also been addressed in literature [11][12][13][14]. However, a limited number of studies have investigated the relationship between admission hemoglobin level and hip fracture outcome [15][16][17]. Distinguishing the role of admission hemoglobin is of major importance, since hemoglobin values at different time points of the perioperative period may indicate different problems, and have consequently different clinical implications.…”