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Blood transfusion rates and predictors following geriatric hip fracture surgery.

BACKGROUND: Postoperative blood product transfusions in elderly hip fracture patients cause concern for morbidity and mortality. The purpose of this study was to identify predictors and short-term sequelae of postoperative transfusion following geriatric hip fracture surgery.

METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to identify geriatric (⩾65 years) patients who sustained operative femoral neck, intertrochanteric, and subtrochanteric hip fractures in 2016. Multivariate regression was used to determine risk-adjusted odds ratios (OR) of associated perioperative risk factors and sequelae of postoperative transfusion.

RESULTS: In total, 8416 geriatric hip fracture patients were identified of whom 28.3% had documented postoperative transfusion. In multivariate analysis, age (OR 1.03 [1.02-1.04], p  < 0.001), preoperative anaemia (OR 4.69 [3.99-5.52], p  = 0.001), female sex (OR 1.61 [1.39-1.87], p  < 0.001), lower BMI (OR 0.97 [0.96-0.98], p  < 0.001), American Society of Anesthesiologists (ASA) classification (OR 1.14 [1.01-1.27], p  = 0.031), COPD (OR 1.30 [1.06-1.59], p  = 0.011), hypertension (OR 1.17 [1.01-1.35], p  = 0.038), increased OR time (OR 1.02 [1.01-1.03], p  < 0.001), and intertrochanteric (OR 2.99 [2.57-3.49], p  < 0.001) and subtrochanteric femur fractures (OR 5.07 [3.84-6.69], p  < 0.001) were independent risk factors for receiving postoperative blood transfusion. Patients with postoperative transfusion had a significantly higher risk-adjusted 30-day mortality (8.4% vs. 6.4%, OR 1.29 [1.02-1.64], p  = 0.035), hospital readmission rate (9.4% vs. 7.7%, OR 1.27 [1.04-1.55], p  = 0.018), and total hospital LOS (7.3 vs. 6.3 days, p  < 0.001).

CONCLUSIONS: Postoperative transfusion is a common occurrence in geriatric fragility hip fractures with multiple risk factors. Careful preoperative planning and multidisciplinary management efforts are warranted to reduce use of postoperative transfusions.

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