J Korean Med Sci.  2020 Sep;35(37):e313. 10.3346/jkms.2020.35.e313.

Blood Transfusion for Elderly Patients with Hip Fracture: a Nationwide Cohort Study

Affiliations
  • 1Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea
  • 2Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
  • 3Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
  • 4Department of Orthopaedic Surgery, Ajou University Medical Center, Suwon, Korea
  • 5Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
  • 6Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
  • 7Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea

Abstract

Background
This nationwide study aimed to investigate the blood transfusion status of elderly hip fracture patients and to examine the effect of packed red blood cell transfusion on all-cause mortality.
Methods
From the Korean National Health Insurance Service-Senior cohort consisting of 588,147 participants aged over 60 years in 2002, a total of 14,744 new-onset hip fracture patients aged 65–99 years were followed up for 11 years. The adjusted hazard ratios (aHRs), risk ratios, and their 95% confidence intervals were estimated by the Cox proportional hazard model and Poisson regression model.
Results
There were 10,973 patients (74.42%) in the transfusion group and 3,771 (25.58%) patients in the non-transfusion group. The mean volume of blood transfusion was 1,164.51 mL (± 865.25; median, 800 mL; interquartile range, 640–1,440). In the multivariable-adjusted Cox proportional hazard model, the transfusion group had 1.34-fold more risk of all-cause mortality than the non-transfusion group (aHR, 1.34; 95% confidence interval [CI], 1.26–1.42). In the multivariate-adjusted Poisson regression model, hip fracture patients in the transfusion group were 1.43 (adjusted risk ratio [aRR], 1.43; 95% CI, 1.09–1.87; p = 0.009) folds more likely to die within 30 days than those in the non-transfusion group. The mortality risk was highest at 90 days (aRR, 1.64; 95% CI, 1.40–1.93; p < 0.001) and slightly decreased at 180 days (aRR, 1.58; 95% CI, 1.40–1.79; p < 0.001) and 1 year (aRR, 1.43; 95% CI, 1.31–1.58; p < 0.001).
Conclusion
In this nationwide representative cohort study, blood transfusion was performed in 75% of hip fracture patients. Even after adjusting for comorbidity and anticoagulant use, the postoperative results (hospitalization, mortality) of the transfusion group did not show significantly worse results than the non-transfusion group. Therefore, adequate patient blood management can only improve the patient's outcome after hip fracture surgery.

Keyword

Blood Transfusion; Elderly; Hip Fracture; Mortality; Packed Red Blood Cells
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