Predisposing factors and morbidity associated with blood transfusion in elderly patients involved hip fracture

1.GOALS

The hip fracture represents one of the major health problems in the elderly because of its high incidence and mortality. 

A significant number of patients will require blood transfusion (1). There is a clear association between transfusion and increased postoperative complications (2).
The aim of our study is to identify the factors that predispose to blood transfusion and the complications associated with it in elderly patients with hip fracture.

2. MATERIAL AND METHODS

Observational study of patients older than 65 years who underwent surgery for proximal femur fracture from 1 June to December 31, 2014.
Medical history were collected, treatment with antiplatelet or oral anticoagulants, haematinics on admission and serial complete blood counts until discharge. 
Further collected surgical delay time, type of anesthesia, type of fracture, surgical technique, transfusion requirements and postoperative complications.
A bivariate analysis was used; the chi-square test for qualitative variables and t-Student for quantitative in order to determine the statistical association between  factors analyzed and transfusion and comorbidities associated with it.

3. RESULTS

A total of 182 patients with hip fracture were included with a mean age of 84 years (± 6.8 years). Eighty per cent were women and 60% were ASA ≥III. Around 65% of the fracture were extracapsular. The surgical technique used was intramedullary nailing (48%), Moore’s prosthesis (22%), DHS (16%) and total hip replacement (12%). The average delay in surgery was 3.2 days. The pre and postoperative hemoglobin average was 11.5 and 9.8 g/dl respectively. The transfusion rate was 59%, administered an average of 1.4 units of packed red blood cells per patient were administred.

Predisposing factors for transfusion were age, hemoglobin at admission, hemoglobin pre and post surgery, ASA, GFR <60mL/min/1,73m2 and the surgical technique. However, no statistically significant differences were found between transfusion and sex or with the prior antiplatelet or anticoagulant therapy.

Blood transfusion was associated with increased number of renal postoperative complications (84%) (p:0,00) and respiratory infections (80%) (p:0,04). No statistical association was found with surgical wound infections, cardiac or neurological complications.


4. CONCLUSIONS

Almost 60% of patients with hip fractures required blood transfusion.
Age, ASA, perioperative anemia, kidney failure as well as the surgical technique were
predisposing factors for transfusion.
Transfused patients had higher postoperative complications, especially infections
respiratory and renal failure.





(1) García-Ercea JA, Cuenca J, Solano VM. Factores predictivos de la necesidad de transfusión en la fractura
subcapital de cadera en pacientes mayores de 65 años. Med Clin (Barc) 2003; 120(5):161-6
(2) Engoren M, Mitchell E, Perring P, Sferra J. The Effect of Erythrocyte Blood Transfusions on Survival After
Surgery for Hip Fracture. J.Trauma 2008; 65(6):1411-5.