Blood transfusions and hip fracture mortality - A retrospective cohort study

Michael Sean Greenhalgh; Benjamin Thomas Vincent Gowers; Karthikeyan P Iyengar; Riad F Adam

doi:10.1016/j.jcot.2021.101506

Blood transfusions and hip fracture mortality - A retrospective cohort study

J Clin Orthop Trauma. 2021 Jul 19:21:101506. doi: 10.1016/j.jcot.2021.101506. eCollection 2021 Oct.

Authors

Michael Sean Greenhalgh¹, Benjamin Thomas Vincent Gowers², Karthikeyan P Iyengar³, Riad F Adam³

Affiliations

¹ Trauma and Orthopaedics, Health Education North West, Manchester, M1 3BN, UK.
² Trauma and Orthopaedics, Health Education East Midlands, Leicester, LE3 5DR, UK.
³ Trauma and Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Southport, PR8 6PN, UK.

Abstract

Background: Hip fractures are associated with serious morbidity and mortality. Low haemoglobin at presentation has been shown to be associated with increased mortality in hip fracture patients. This comorbid patient group commonly receives packed red cell blood transfusions during their hospital admission, the impact of which is less clear.

Aims and objectives: We aim to assess the rate, appropriateness and impact of blood transfusions on one-year mortality in hip fracture patients. We also aim to assess the impact of patients taking anticoagulant medications at presentation on the rates of blood transfusions in this patient group.

Methods: A retrospective cohort study of 324 consecutive hip fracture patients. Data was collected from the national hip fracture database, electronic patient records and PACS.

Results: 75 patients received a blood transfusion. Receiving a blood transfusion increased absolute risk of one-year mortality by 2.466 (p < 0.05). Adjusted for age, sex, comorbidities, residence prior to admission and time from presentation to surgery increased the risk of one-year mortality was 2.790 (p < 0.05).28% of patients who went on to receive a transfusion had a haemoglobin of less than 100 g/L at presentation. 94.6% of transfused patients had a pre-transfusion haemoglobin of less than 90 g/L. There was no increased risk of requiring a blood transfusion if anticoagulant medication was being taken at presentation.

Conclusion: Receiving a blood transfusion during an admission for hip fracture carried an increased risk of one-year mortality of almost two and a half times. With appropriate preoperative optimisation, taking an anticoagulant medication at presentation did not increase the risk of requiring a transfusion. Most blood transfusions were administered appropriately using thresholds. Just over a quarter of patients who received a transfusion had an admission haemoglobin of less than 100 g/L, showing it as a poor predictor of blood transfusion requirement during admission.

Keywords: Anticoagulation; Blood transfusion; Hip fracture; Neck of femur; Trauma.