gms | German Medical Science

Objective: Hip fractures often concern elderly patients with a high degree of co-morbidity and therefore suscepti-ble for the associated postoperative morbidity and mortality. According to the literature, several factors have an influence on the amount and severity of postoperative complications after hip fractures. Low preoperative haemoglobin levels (Hb) in elderly patients seem to be associated with increased short-term morbidity and even mortality after surgery.

The aim of this study was therefore to establish the impact of anaemia and blood transfusion on post-operative recovery of hip fracture patients.

Methods: For this study hip fracture patients were included, who were admitted to the surgical department of our hospital between January 2005 and June 2009. Data was retrospectively retrieved and reviewed from the patients records. Exclusion criteria were age <65 years, conservative treatment, transfers to an-other hospital before surgery, polytrauma’s and pathologic fractures. Anaemia was defined as Hb be-low 13.0 grams per decilitre for males and below 12.0 grams per decilitre for females. Primary out-comes were postoperative complications, length of stay in the hospital, re-admissions and in hospital mortality

Results and conclusions: In total 465 patients with a hip fracture were included, of which 75,3% were women. Mean age was 83.2 years (range 65–99). Mean Hb at admission was 12.4±1.5 g/dL, direct postoperative 9,9±1.6 g/dL and at discharge 10,6±1.3 g/dL. Anaemia was present in 58.3% of all patients on admission, 95.4% direct postoperative and 89.1% at discharge. Mean Hb drop following surgery (from admission to postoperative level) was 2.6±1.6 g/dL, and this was correlated to an increased length of stay (p<0.008). Overall, 200 patients (43.1%) received an average of 6.2 units of Red Blood Cells (RBC’s). Of all transfusions, 70% was given the first day after surgery. Lower Hb at admission was associated with more readmissions (p<0.04), more postoperative complications (p<0.019) and an increased length of stay (p<0.003) but was not associated with lower odds of in hospital death (p<0.69). The number of RBC units was correlated to a decreased length of stay (p<0.0003) and an increased num-ber of postoperative deliriums (p<0.036). Transfusion was not associated with lower odds of re-admission and death.

According to the results of this study the average patient with hip fracture experienced a large drop in Hb following surgery. Lowered Hb at admission was associated with poor outcome, more readmis-sions and an increased length of stay. Treatment of anaemia with RBC transfusion had a positive influ-ence on the length of stay. Early diagnosis and treatment of anaemia in elderly hip fracture patients seems to be an important factor in postoperative recovery, though more research is necessary for this to be affirmed.