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

Authors
  • 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)
Type
Published Article
Journal
Journal of Korean medical science
Publication Date
Sep 21, 2020
Volume
35
Issue
37
Identifiers
DOI: 10.3346/jkms.2020.35.e313
PMID: 32959543
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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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