Discharge hemoglobin and functional outcome of elderly hip fractured patients undergoing rehabilitation

Abstract

Aim: Low hemoglobin level is considered a marker of poor functional outcome. The objective of this study was to explore possible relationship of discharge hemoglobin levels and functional outcome of elderly hip fracture patients, undergoing in-hospital rehabilitation.

Methods: A retrospective chart review study, comprising consecutive elderly patients suffering traumatic hip fractures. Main outcome measurement was the functional outcome of patients, as assessed by motor and total Functional Independence Measurement (FIM) scores upon admission and discharge.

Results: Mean discharge hemoglobin levels were significantly associated with prefracture function and Mini Mental State Examination (MMSE) score (P=0.002 and P=0.01, respectively). The authors observed a significant positive correlation between serum hemoglobin and total FIM at discharge (Pearson's coefficient =0.13; P=0.005) as well as with motor FIM at discharge (Pearson's coefficient =0.13; P=0.005). Regression analyses showed that high MMSE scores (beta=0.55; P<0.001), female gender (beta=0.07; P=0.01), younger age (beta=-0.10, P=0.001) and a better pre-fracture function (beta=-0.27 P<0.001) are associated with higher total FIM scores upon discharge. Neither discharge hemoglobin levels nor the number of transfused blood packs were significantly associated with better total FIM, motor FIM, FIM gain or FIM= or >80.scores.

Conclusion: Higher hemoglobin at discharge was not associated with a better postfracture function, as reflected by FIM scores. The authors suggest that clinically reasonable low hemoglobin levels are not associated with adverse functional outcome of elderly hip fracture patients, thus, actively correcting hemoglobin levels, per se, may not result in better functional outcomes in this population.