Post-Operative Red Cell Distribution Width Increase May Predict Mortality in Patients Operated for Hip Fracture

Hip fractures, with significant morbidity and mortality, increase day by day with the aging population. Inflammation may play a critical role in addition to deep vein thrombosis due to pulmonary embolism in morbidity and mortality after hip fractures and hip arthroplasty surgeries. The aim of the study is to investigate the impacts of post-operative changes in inflammatory markers such as red blood cell distribution width (RDW), mean platelet volume (MPV), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) on 30-day mortality rates in patients operated for hip fracture.

The data of 231 patients operated for hip fracture at a state hospital, between 2017 and 2020, were evaluated retrospectively. Survivor and non-survivor patients were compared in terms of whether or not they needed intensive unit care, length of hospital stay, intensive care unit (ICU) length of stay, and test parameters (RDW, MPV, PLR, and NLR).

Of the patients, 61% were women and the mean age was 77.2 ± 10.7 years. The 30-day mortality (6 patients in-hospital, 10 patients after discharge) developed in 16 patients (6.9%). The mean age, the incidence of preoperative anemia, ICU hospitalization rate and ICU length of stay increased significantly in non-survivor patients. A statistically significant increase was observed in RDW (p = 0.009), MPV (p < 0.001), NLR (p < 0.001), and PLR (p < 0.001) values in postoperative complete blood count testing in both survivor and non-survivor patients. Among the CBC parameters, only the increase in RDW levels was found to be statistically significant in non-survivor patients compared to survivors postoperatively (p < 0.001). The optimal cut-off value for the RDW difference in predicting 30-day mortality was calculated as > 0.8. The increase in preoperative and postoperative RDW differences in multivariate logistic regression was found to be positively associated with 30-day mortality.

Detecting the change in RDW levels can be useful and practical for the clinician not only in revealing the patients under risk, but also in the management of such patients. Further prospective and multi-center clinical studies that will support our results and aim to reveal the reason for this change will contribute to the reduction of mortality in such patients.