Factors Affecting Transfusion Rate for Patients After Hip Fracture

Hip fractures are a common indication for red blood cell transfusion among elderly patients. Blood transfusion may be clinically necessary, yet it carries risks and should be anticipated according to patient and surgical characteristics.

This retrospective study aimed to identify clinical and perioperative factors associated with the need for blood transfusion among patients hospitalized with hip fracture.

The study included 150 patients with hip fracture treated at the Orthopedic Department of Bnei Zion Medical Center between April 2014 and June 2015. The transfusion group included 100 patients who received blood transfusions, and the control group included 50 surgically treated patients who did not require transfusion. Group comparisons were performed using t tests, chi-square tests, Fisher exact tests, and multivariable logistic regression.

Transfused patients were older than non-transfused controls (84.5 ± 7.4 vs 80.2 ± 8.1 years; P = 0.002). Age above 90 years (34% vs 14%; P = 0.030), subtrochanteric fracture (20% vs 6%; P = 0.031), aspirin use (41% vs 18%; P = 0.006), surgery duration exceeding 90 minutes (33% vs 8%; P = 0.0079), and B+ blood type (26% vs 6%; P = 0.041) were significantly associated with transfusion in univariate analysis. In multivariable logistic regression, age above 90 years (OR, 2.64; 95% CI, 1.08-6.45; P = 0.033), subtrochanteric fracture (OR, 3.21; 95% CI, 1.01-10.18; P = 0.048), and surgery duration exceeding 90 minutes (OR, 4.87; 95% CI, 1.62-14.63; P = 0.005) remained significant predictors.

Among elderly patients with hip fracture, advanced age, subtrochanteric fracture, and prolonged surgical duration were the main independent predictors of blood transfusion. Aspirin use and B+ blood type were significant in univariate analysis but should be interpreted cautiously. Recognition of high-risk profiles may improve perioperative planning, blood bank preparation, and patient management.