Department of Internal Medicine, Perioperative Medicine, and Department of Orthopaedic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Department of Orthopaedic Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium.
Bone Joint J. 2019 Sep;101-B(9):1122-1128. doi: 10.1302/0301-620X.101B9.BJJ-2019-0526.R1.
Low haemoglobin (Hb) at admission has been identified as a risk factor for mortality for elderly patients with hip fractures in some studies. However, this remains controversial. This study aims to analyze the association between Hb level at admission and mortality in elderly patients with hip fracture undergoing surgery.
All consecutive patients (prospective database) admitted with hip fracture operated in a tertiary hospital between 2012 and 2016 were analyzed. We collected patient characteristics, time to surgery, duration and type of surgery, comorbidities, Hb at admission, nadir of Hb after surgery, the use and amount of red blood cells (RBCs) transfusion products, postoperative complications, and death. The main outcome measures were mortality at 30 days, 90 days, 180 days, and one year after surgery.
We included 829 patients; the mean age was 81 years (sd 11). Mortality at 30 days, 90 days, 180 days, and one year was 5.7%, 12.3%, 18.1%, and 23.5%, respectively. The highest mortality was observed in patients aged over 80 years (162/557, 29%) and in male patients (85/267, 32%). Survival at 90 days, 180 days, and one year after surgery was significantly lower in patients with a Hb level below 120 g/l at admission. In multivariate analysis, Hb level below 120 g/l at admission was found to be an independent factor associated with mortality (adjusted hazard ratio (aHR) 1.68 (95% confidence interval (CI) 1.22 to 2.31); p = 0.001), along with age (aHR 1.06 (95% CI 1.04 to 1.06); p < 0.001), male sex (aHR 2.19 (95% CI 1.61 to 2.96); p < 0.001), and need for RBC transfusions (aHR 1.10 (95% CI 1.02 to 1.19); p = 0.01).
Our results suggest that low Hb at admission along with age and RBC transfusions is significantly associated with short- and long-term mortality after hip fracture surgery, independently of comorbidity confounders. Further studies should be performed to understand how preoperative Hb could be taken into account in perioperative management. Cite this article: 2019;101-B:1122-1128.
一些研究表明，入院时低血红蛋白（Hb）是老年髋部骨折患者死亡的危险因素。然而，这仍然存在争议。本研究旨在分析入院时 Hb 水平与接受手术治疗的老年髋部骨折患者死亡率之间的关系。
分析了 2012 年至 2016 年间在一家三级医院接受髋部骨折手术的所有连续患者（前瞻性数据库）。我们收集了患者特征、手术时间、手术持续时间和类型、合并症、入院时的 Hb 值、手术后 Hb 值最低值、红细胞（RBC）输注产品的使用和数量、术后并发症和死亡情况。主要观察指标为手术后 30 天、90 天、180 天和 1 年的死亡率。
共纳入 829 例患者，平均年龄为 81 岁（标准差 11 岁）。术后 30 天、90 天、180 天和 1 年的死亡率分别为 5.7%、12.3%、18.1%和 23.5%。最高的死亡率出现在 80 岁以上的患者（557 例中有 162 例，29%）和男性患者（267 例中有 85 例，32%）中。在入院时 Hb 水平低于 120g/l 的患者中，术后 90 天、180 天和 1 年的生存率明显较低。多因素分析显示，入院时 Hb 水平低于 120g/l 是与死亡率相关的独立因素（调整后的危险比（aHR）为 1.68（95%置信区间（CI）为 1.22 至 2.31）；p=0.001），此外还有年龄（aHR 为 1.06（95% CI 为 1.04 至 1.06）；p<0.001）、男性（aHR 为 2.19（95% CI 为 1.61 至 2.96）；p<0.001）和需要 RBC 输血（aHR 为 1.10（95% CI 为 1.02 至 1.19）；p=0.01）。
我们的研究结果表明，入院时 Hb 水平较低，加上年龄和 RBC 输血，与髋部骨折手术后短期和长期死亡率显著相关，且不受合并症混杂因素的影响。应进一步开展研究，以了解术前 Hb 如何在围手术期管理中得到考虑。 引用本文：2019;101-B:1122-1128.
