Blood Transfusion for Elderly Patients with Hip Fracture: a Nationwide Cohort Study
10.3346/jkms.2020.35.e313
- Author:
Suk-Yong JANG
1
;
Yong-Han CHA
;
Jun-IL YOO
;
Taeho OH
;
Jung-Taek KIM
;
Chan Ho PARK
;
Won-Sik CHOY
;
Yong-Chan HA
;
Kyung-Hoi KOO
Author Information
1. Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea
- Publication Type:Original Article
- From:Journal of Korean Medical Science
2020;35(37):e313-
- CountryRepublic of Korea
- Language:0
-
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.
