Department of Orthopedics, Chinese PLA General Hospital, Beijing, People's Republic of China.
Department of Rehabilitation, the Second Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China.
Clin Interv Aging. 2023 Apr 18;18:639-653. doi: 10.2147/CIA.S404211. eCollection 2023.
To evaluate the impact of preoperative anemia on postoperative complications after hip fracture surgery.
We conducted a retrospective study including hip fracture patients at a teaching hospital between 2005 and 2022. We defined preoperative anemia as the last hemoglobin measurement level before surgery < 130 g/L for men and < 120 g/L for women. The primary outcome was a composite of in-hospital major complications, including pneumonia, respiratory failure, gastrointestinal bleeding, urinary tract infection, incision infection, deep venous thrombosis, pulmonary embolism, angina pectoris, arrhythmia, myocardial infarction, heart failure, stroke, and death. Secondary outcomes were cardiovascular events, infection, pneumonia, and death. We used multivariate negative binomial or logistic regression to evaluate the impact of anemia and its severity, categorized as mild (90-130 g/L for men, 90-120 g/L for women) or moderate-to-severe (< 90 g/L for both) anemia on outcomes.
Of the 3540 included patients, 1960 had preoperative anemia. 188 anemic patients experienced 324 major complications, while 63 non-anemic patients had 94 major complications. The risk of major complications was 165.3 (95% CI, 149.5-182.4) and 59.5 (95% CI, 48.9-72.3) per 1000 persons in anemic and non-anemic patients, respectively. Anemic patients were more likely to have major complications than non-anemic patients (adjusted incidence rate ratio (aIRR), 1.87; 95% CI, 1.30-2.72), which was consistent in mild (aIRR, 1.77; 95% CI, 1.22-2.59) and moderate-to-severe (aIRR, 2.97; 95% CI, 1.65-5.38) anemia. Preoperative anemia also increased the risk of cardiovascular events (aIRR, 1.96; 95% CI, 1.29-3.01), infection (aIRR, 1.68; 95% CI, 1.01-2.86), pneumonia (adjusted odds ratio (aOR), 1.91; 95% CI, 1.06-3.57), and death (aOR, 3.17; 95% CI, 1.06-11.89).
Our findings suggest that even mild preoperative anemia is associated with major postoperative complications in hip fracture patients. This finding highlights considering preoperative anemia as a risk factor in surgical decision-making for high-risk patients.
评估术前贫血对髋部骨折手术后术后并发症的影响。
我们进行了一项回顾性研究，纳入了 2005 年至 2022 年期间在一家教学医院接受髋部骨折治疗的患者。我们将术前贫血定义为手术前最后一次血红蛋白测量值男性<130g/L，女性<120g/L。主要结局是住院期间主要并发症的综合指标，包括肺炎、呼吸衰竭、胃肠道出血、尿路感染、切口感染、深静脉血栓形成、肺栓塞、心绞痛、心律失常、心肌梗死、心力衰竭、中风和死亡。次要结局为心血管事件、感染、肺炎和死亡。我们使用多变量负二项式或逻辑回归来评估贫血及其严重程度（分为轻度贫血（男性 90-130g/L，女性 90-120g/L）或中重度贫血（男性和女性均<90g/L））对结局的影响。
在纳入的 3540 名患者中，有 1960 名患者术前存在贫血。188 名贫血患者发生 324 例主要并发症，而 63 名非贫血患者发生 94 例主要并发症。贫血患者每 1000 人中发生主要并发症的风险为 165.3（95%CI，149.5-182.4），而非贫血患者为 59.5（95%CI，48.9-72.3）。与非贫血患者相比，贫血患者发生主要并发症的风险更高（调整发病率比（aIRR），1.87；95%CI，1.30-2.72），在轻度贫血（aIRR，1.77；95%CI，1.22-2.59）和中重度贫血（aIRR，2.97；95%CI，1.65-5.38）中均如此。术前贫血还增加了心血管事件（aIRR，1.96；95%CI，1.29-3.01）、感染（aIRR，1.68；95%CI，1.01-2.86）、肺炎（调整后优势比（aOR），1.91；95%CI，1.06-3.57）和死亡（aOR，3.17；95%CI，1.06-11.89）的风险。
我们的研究结果表明，即使是轻度术前贫血也与髋部骨折患者的术后主要并发症有关。这一发现强调了将术前贫血视为高危患者手术决策的一个风险因素。
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