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

  • Jang, Suk Yong1
  • Cha, Yong Han2
  • Yoo, Jun Il3
  • Oh, Taeho2
  • Kim, Jung Taek4
  • Park, Chan Ho5
  • Choy, Won Sik2
  • Ha, Yong Chan6
  • Koo, Kyung Hoi7
  • 1 Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea. , (North Korea)
  • 2 Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea. , (North Korea)
  • 3 Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea. [email protected] , (North Korea)
  • 4 Department of Orthopaedic Surgery, Ajou University Medical Center, Suwon, Korea. , (North Korea)
  • 5 Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea. , (North Korea)
  • 6 Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea. , (North Korea)
  • 7 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea. , (North Korea)
Published Article
Journal of Korean medical science
Publication Date
Sep 21, 2020
DOI: 10.3346/jkms.2020.35.e313
PMID: 32959543


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. 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. 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). 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. © 2020 The Korean Academy of Medical Sciences.

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