Abstract
Geriatric hip fracture patients have a 14-fold higher 30-day mortality than their age matched peers. Up to 50% of these patients receive blood transfusion perioperatively. Both restrictive and liberal transfusion policies are controversial in this population. Aim: The longitudinal description of transfusion practice in geriatric hip fracture patients in a major trauma centre.
An 8-year (2002–2009) retrospective study was performed on patients over the age of 65 undergoing hip fracture fixation. Yearly transfusion rate; the influence of transfusion on 30-day, 90-day and 1-year mortality and length of stay (LOS) was investigated. On admission haemoglobin (Hb), pre-transfusion Hb and post-transfusion Hb and their effect on transfusion requirement and mortality was also reviewed. The yearly changes in on-admission and pre-transfusion Hb were also examined. The influence of comorbidities, timing, procedure performed and operation duration on transfusion requirement and mortality was also studied. From the 3412 patients, 35% (1195) received transfusion during their hospital stay. There was no change in age, gender and co-morbidities during the study. Thirty-day mortality improved from 12.4% in 2002 to 7% in 2009. The transfusion rate showed a gradual decrease from the highest of 48.3% (2003) to 22.9% (2009) (Pearson correlation - R2 = −0.707, p=0.05). There was no change during the study period in on-admission and pre-transfusion Hb. The mortality for non-transfused and transfused patients was [9.6% vs. 10.3 % (30-day)], [17.2% vs. 18.4%(90-day)] and [27% vs. 30.5%(1-year), p=0.031]. LOS was 11±9 for non-transfused patients and 13±10 (p<0.001) for transfused patients. Patients with more comorbidities experienced a higher transfusion rate, (0 – 31%, 1 – 38%, 2 – 46%, 3 – 57%), (Pearson Chi-squared, p<0.001). The need for transfusion by different procedures in decreasing order was 47.6% intramedullary device, 44.0% DHS, 25.2% cemented hemiarthroplasty, 23.6% Austin-Moore, and 5.5% cannulated screws. The length of the operation increases the chance of transfusion (<1hrs, – 33%, 1–2hrs – 35%, 2–3hrs – 41%, >3 hours – 65%), (Pearson Chi-squared, p=0.010). Preoperative waiting time had no influence on transfusion frequency (<24hrs – 36%, 24–48hrs – 34%, 48–96hrs – 36%, >96hrs – 33%), (Pearson Chi-squared, p=0.823).
The percentage of transfused geriatric hip fracture patients halved during the eight-year period without changes in demographics and co-morbidities. Perioperative transfusion of hip fracture patients is associated with higher 1-year mortality and increased LOS. A more restrictive transfusion practice has been safe and may be a factor in the improved 30-day mortality.
