Geriatr Orthop Surg Rehabil. 2021 May 16;12:21514593211015118. doi: 10.1177/21514593211015118. eCollection 2021.
Perioperative Transfusion Associated With Increased Morbidity and Mortality in Geriatric Patients Undergoing Hip Fracture Surgery.
Geriatric orthopaedic surgery & rehabilitation
Piyush Gupta, Kevin K Kang, Jordan B Pasternack, Elliot Klein, Dennis E Feierman
Affiliations
Affiliations
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA.
- Department of Orthopedics, Maimonides Medical Center, Brooklyn, NY, USA.
- Department of Anesthesiology, Donald and Barbara Zucker School of Medicine at Hofstra, Queens NY, USA.
PMID: 34035979
PMCID: PMC8132085 DOI: 10.1177/21514593211015118
Abstract
INTRODUCTION: Both conservative and liberal transfusion thresholds, in regard to hematocrit and hemoglobin levels, have been widely studied with varying outcomes. The aim of this study was to evaluate if transfusion administered peri- (anytime during the admission), pre-, intra-, or postoperatively an its association with morbidity and mortality in the geriatric population undergoing hip surgery.
METHODS: This study was an institutional review board approved retrospective analysis of data collected from 841 patients at a single urban institution who underwent surgical repairs for hip fractures from 2008 to 2010.
RESULTS: Our analysis included data from 841 surgical patients. Mean patient age was 83, 74% were female, 48% received spinal anesthesia while 52% underwent general anesthesia. Out of 841 patients, 425 were transfused during the perioperative period. Most transfusions occurred postoperatively. Perioperative, intraoperative and postoperative transfusion was associated with an increase in post-operative AKI. Intraoperative blood transfusion was associated with an increase in morbidity (11.6% increased to 22.2%) by 1.9 fold, AKI (3.9% increased to 11.1%) by 2.8 fold, as well as an increase in mortality (5.2 increased to 15.6%) within 60 days by 3 fold.
CONCLUSIONS: This may suggest that patients transfused prior to surgery, despite having met a specific trigger hemoglobin level earlier, may have been treated before deteriorating to a point that would cause future systemic implications.
© The Author(s) 2021.
Keywords: ASA; geriatric medicine; morbidity; mortality; transfusion
Conflict of interest statement
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
References
- J Orthop Trauma. 2006 Nov-Dec;20(10):675-9 - PubMed
- J Bone Joint Surg Br. 2006 Aug;88(8):1053-9 - PubMed
- Cochrane Database Syst Rev. 2015 Apr 21;(4):CD009699 - PubMed
- Lancet. 2015 Mar 28;385(9974):1183-9 - PubMed
- Am J Orthop (Belle Mead NJ). 2016 Jan;45(1):E12-9 - PubMed
- Bone Joint J. 2015 Mar;97-B(3):383-90 - PubMed
- J Arthroplasty. 2010 Sep;25(6 Suppl):134-7 - PubMed
- Osteoporos Int. 2018 Mar;29(3):717-722 - PubMed
- Injury. 2013 Dec;44(12):1916-8 - PubMed
- J Trauma. 2008 Dec;65(6):1411-5 - PubMed
- Vox Sang. 2012 Oct;103(3):223-30 - PubMed
- J Bone Joint Surg Am. 2018 Feb 21;100(4):288-294 - PubMed
- Acta Orthop. 2015 Jun;86(3):363-72 - PubMed
- Injury. 2015;46(6):1028-35 - PubMed
- Geriatr Orthop Surg Rehabil. 2018 Sep 19;9:2151459318795260 - PubMed
- Acta Orthop. 2014 Feb;85(1):54-9 - PubMed
- Osteoporos Int. 2006 Dec;17(12):1726-33 - PubMed
- J Orthop Trauma. 1997 May;11(4):260-5; discussion 265-6 - PubMed
- JAMA Intern Med. 2014 Aug;174(8):1273-80 - PubMed
- J Orthop Trauma. 2004 Jul;18(6):369-74 - PubMed
- Osteoporos Int. 1992 Nov;2(6):285-9 - PubMed
- J Orthop Trauma. 2018 Jan;32(1):34-38 - PubMed
- N Engl J Med. 2011 Dec 29;365(26):2453-62 - PubMed
- Injury. 2011 Feb;42(2):178-82 - PubMed
- Eur J Anaesthesiol. 2018 Dec;35(12):972-979 - PubMed
- Hip Int. 2020 Mar;30(2):204-209 - PubMed
- J Surg Res. 2002 Feb;102(2):237-44 - PubMed
- Anesth Analg. 2019 Sep;129(3):819-829 - PubMed
Publication Types