The impact of hip fracture anatomy on admission haemoglobin levels and perioperative transfusion requirements: a 32-year experience.

PURPOSE

Hip fracture patients require perioperative optimisation, often including blood transfusion. In this study, we sought to evaluate whether admission haemoglobin level or perioperative transfusion differs among patients admitted with intracapsular or extracapsular hip fractures, and whether this practice has evolved over 32 years in our unit.

METHODS

We performed a retrospective analysis of data collected prospectively for all hip fracture patients, January 1989-August 2021. Exclusion criteria were age < 60 years, pathological hip fractures or surgical treatment other than fixation for extracapsular fracture or hemiarthroplasty for intracapsular fracture. We collated demographic data, admission haemoglobin, hours to surgery and perioperative blood transfusion records. Chi-squared tests and t-tests were utilised to compare these data between fracture types, and a multivariable logistic regression analysis was performed.

RESULTS

A total of 12,166 patients were screened from our internal database, and 8578 patients met the inclusion criteria (3928 intracapsular hip fractures, 4603 extracapsular hip fractures). 76.3% (6544) were female. Patients admitted with intracapsular fractures had significantly higher haemoglobin on admission than those with extracapsular fractures (124.5 g/L vs. 119.4 g/L, p < 0.001). Preoperative and intraoperative transfusion requirements were lower for intracapsular fractures, with 15.5% (609/3928) requiring perioperative transfusion compared with 37.7% (1736/4603) of extracapsular fracture patients (p < 0.001). Time to surgery was similar between groups (28.37 h vs. 28.02 h, p = 0.548). Over the study period, transfusion has declined each year (intracapsular R = 0.568, p < 0.001; extracapsular R = 0.840, p < 0.001). Multivariable regression analysis highlighted increasing age, lower admission haemoglobin, extracapsular fracture, and intramedullary nailing for extracapsular fracture as risk factors for perioperative transfusion.

CONCLUSION

We demonstrate that individuals with intracapsular hip fractures generally present with higher admission haemoglobin concentration and require fewer blood transfusions compared to those with extracapsular fractures. Over 32 years, our overall transfusion rate has declined, reflecting evolving surgical techniques and updated transfusion protocols.