Effect of blood transfusion on survival after hip fracture surgery

• Published in: European journal of orthopaedic surgery & traumatology Vol. 28; no. 7; pp. 1297 - 1303
• Main Authors: Smeets, S. J. M., Verbruggen, J. P. A. M., Poeze, M.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.10.2018; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Blood Transfusion - methods; Blood transfusions; Female; Follow-Up Studies; Fractures; Health risk assessment; Hemoglobin; Hip Fractures - surgery; Humans; Male; Medicine; Medicine & Public Health; Mortality; Netherlands - epidemiology; Original Article • HIP - ANESTHESIA; Original • HIP - ANESTHESIA; Postoperative Care - methods; Postoperative Complications - mortality; Postoperative Complications - therapy; Propensity Score; Retrospective Studies; Risk Factors; Surgical Orthopedics; Survival Rate; Time Factors; Traumatic Surgery; Treatment Outcome; Netherlands; Blood transfusion; Survival; Hip fracture surgery; Morbidity
• DOI: 10.1007/s00590-018-2205-z
• ISSN: 1633-8065

Background Our primary goal was to audit the incidence of erythrocyte blood transfusion (EBT) after hip fracture surgery and study the effects on perioperative complications and early and late mortality. Methods In a retrospective cohort study all patients 65 years old and above treated operatively for an acute hip fracture were included over a 48-month period with a 2-year follow-up period. Postoperative hemoglobin levels were used to investigate at what threshold EBT was used. The relation between EBT and perioperative complications and survival was analyzed with multivariate regression analysis. A propensity score for predicting the chance of receiving an EBT was calculated and used to differentiate between transfusion being a risk factor for mortality and other related confounding risk factors. Mortality was subdivided as in-hospital, 30-day, 1-year and 2-year mortality. Results Of the 388 included patients, 41% received a blood transfusion. The postoperative hemoglobin level was the strongest predictor for EBT. Patients who received EBT had a significant longer hospital stay and more postoperative cardiac complications, even after adjustment for confounders. Multivariate analysis for mortality showed that EBT was a significant risk factor for early as well as late mortality, but after adding the propensity score, EBT was no longer associated with increased mortality. Conclusion There was no effect of EBT on mortality after correction with propensity scoring for predictors of EBT. Transfusion in patients treated operatively for hip fracture should be evenly matched with their cardiovascular risk during the perioperative phase.