Pre-operative Red Blood Cell Transfusion for Chronically Anemic Hip Fracture Patients is Associated with Increased...

Acute and chronic anemia is common in hip fracture patients, and blood transfusions may be necessary during pre-operative optimization. However, transfusions increase the risk of complications. This study evaluates the impact of red blood cell (RBC) transfusion timing on outcomes including mortality, major complications, and readmission rates for hip fracture patients who present with chronic anemia of at least 6 months.

A retrospective chart review of chronically anemic hip fracture patients was conducted to assess demographics, lab values, transfusion timing, and outcomes. Charlson comorbidity index (CCI) and Score for Trauma Triage in the Geriatric and Middle Aged (STTGMA) were calculated for each patient. Patients were stratified into three transfusion cohorts: pre-operative transfusion, post-operative transfusion, and no-transfusion. Variables were compared using Chi-square and ANOVA as appropriate. Binary logistic regression analysis was performed to account for confounding variables.

Patients who received a pre-operative RBC transfusion had a significantly higher risk of 1-year mortality (25.5%) compared to the no RBC transfusion cohort (8.4%) (odds ratio = 7.670) (p = 0.012). There was a significant difference between the no-transfusion cohort, pre-operative transfusion cohort, and post-operative transfusion cohort for 1-year mortality (8.4%, 25.5%, 17.6%, respectively; p = 0.006), overall mortality (9.2%, 32.7%, 23.0%, respectively; p < 0.001), major complications (10.6%, 32.7%, 21.6%, respectively; p < 0.001). Post-operative transfusion or no-transfusion was not linked to readmission rates, complications, or mortality.

Pre-operative RBC transfusion is an independent risk factor for 1-year mortality in chronically anemic hip fracture patients, suggesting careful consideration of transfusion timing.