Thurs., 10/4/12 Hip Fractures, PAPER #38, 4:41 pm OTA-2012
No Effects of Blood Transfusion on Survival After Hip Fracture Surgery
Stef J.M. Smeets, MD; Martijn Poeze, MD, PhD; Jan Verbruggen, MD, PhD;
Maastricht University Medical Center, Maastricht, The Netherlands
Purpose: Our primary goal was to audit the incidence of erythrocyte blood transfusion (EBT) after hip fracture surgery, to identify risk factors for blood transfusion, and study the effects on perioperative complications and survival.
Methods: In a retrospective cohort study, all patients 65 years old and above treated operatively for an acute hip fracture between 2003 and 2006 were included, with a 2-year follow- up period. We analyzed patient charts regarding patient and operation characteristics. Postoperative hemoglobin levels were used to investigate at what threshold EBT was used. The relation between EBT and perioperative complications and survival was analyzed with multivariate regression analysis. A propensity score for predicting the chance of receiving an EBT was calculated and used to differentiate between transfusion being a risk factor for mortality and other related confounding risk factors. Mortality was subdivided as in-hospital, 1-month mortality, 1-year mortality, and 2-year mortality.
Results: Of the 388 included patients, 41% received a blood transfusion. The postoperative hemoglobin level was the only significant predictor for EBT. Patients who received EBT had significantly more postoperative cardiac complications, even after adjustment for confounders. Multivariate analysis for mortality showed that EBT was a significant risk factor for early as well as late mortality, but after adding the propensity score, EBT was no longer associated with increased mortality.
Conclusion: EBT is associated with an increased frequency of cardiovascular complications after hip fracture surgery. There was no effect of EBT on mortality after correction with propensity scoring for predictors of EBT. This suggests that factors for transfusion are predictors for mortality itself.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.