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THE CONSEQUENCES OF BLOOD TRANSFUSION FOR HIP FRACTURES



Abstract

Introduction and Aims: Immune suppression induced by blood transfusion may be a determinant in the development of post-operative infectious complications. This study was to determine if blood transfusion was an independent risk factor for mortality and wound infections after hip fracture surgery.

Method: A retrospective cohort study analysing the prospectively collected data for 3571 hip fracture patients undergoing surgery over the last 15 years at one institution. Out of these 1068 patients underwent blood transfusion. Mortality was related to whether the patient was transfused, and adjusted for confounding predictors of mortality (age, sex, pre-operative haemoglobin concentration residential status, ASA grade and mobility).

Results: 3461 cases remained after 290 (7.7%) cases had to be excluded for missing data in the multivariate analysis. The mortality values at 30,120 and 365 days in the transfused group were 95 (8.9%), 247 (23.1%) and 381 (35.7%), whereas corresponding values in the non-transfused group were 181 (7.2%), 374 (14.9%) and 626 (25.0%). This difference at six and 12 months was statistically significant. With adjustment for confounding variables with a Cox regression mode the hazard ratio for mortality at one year was 1.11 (95% CI 0.96–1.29, p value 0.17). Superficial infection occurred in 22 patients (2.0%) in the transfused group and there were 10 deep infections (0.9%). This was not a statistically significant difference from the incidence in the non-transfused group, 48 cases (1.9%) and 15 (0.6%) respectively.

Conclusion: In conclusion, although it appears that blood transfusions are associated with an increased mortality, when this is adjusted for baseline characteristics and confounding variables, the difference is not statistically significant. Neither was there an increased incidence of wound infection in the transfused patients.

These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.

None of the authors is receiving any financial benefit or support from any source.