Preoperative Anemia, Functional Outcomes, and Quality of Life After Hip Fracture Surgery

Abstract

Objectives: To determine whether preoperative anemia, perioperative blood transfusion, and predischarge anemia affect function and health-related quality of life (HRQoL) after hip fracture surgery.

Design: Retrospective single-center cohort study PARTICIPANTS: Individuals undergoing traumatic hip fracture surgery from 2012 to 2016 (N=973).

Measurements: Demographic data, Charlson Comorbidity Index, preoperative hemoglobin level, perioperative blood transfusion, predischarge hemoglobin level, type of surgery (replacement or fixation). Anemia was divided into quintiles at 10.0, 11.0, 12.0, and 13.0 g/dL. Baseline, 6-week, and 6-month Harris Hip Scale (HHS), Parker Mobility Scale (PMS), and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) scores were obtained. PMS; HHS and SF-36 role physical (RP), physical function (PF), and social functioning (SF) domains had more than 20% change from baseline to 6 weeks and from 6 weeks to 6 months. Univariate and multivariate analyses were conducted to examine the association between preoperative anemia, transfusion and predischarge anemia on 6-month scores.

Results: On univariate analysis, preoperative hemoglobin less than 10.0 g/dL was associated with lower baseline prefall PMS, PF, RP, and SF scores. Predischarge anemia did not affect 6-month scores. On multivariate analysis, preoperative anemia (hemoglobin <10.0 g/dL) was associated with lower 6-month HHS, PMS, PF, and RP scores, whereas transfusion was not significant.

Conclusion: Preoperative anemia (hemoglobin <10.0 g/dL) is associated with poorer physical function and HRQoL after hip fracture surgery. Perioperative blood transfusion and predischarge anemia had no effect.

Keywords: anemia; elderly; health-related quality of life; hip fracture; transfusion.