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. 2023 Apr 18:18:639-653.
doi: 10.2147/CIA.S404211. eCollection 2023.

Preoperative Anemia and Risk of In-hospital Postoperative Complications in Patients with Hip Fracture

Yu Jiang #  1 , Xisheng Lin #  2 , Yilin Wang  1 , Jia Li  1   3 , Guoqi Wang  4 , Yutong Meng  5 , Ming Li  1   3 , Yi Li  1   3 , Yan Luo  1   3 , Zefu Gao  1 , Pengbin Yin  1   3 , Licheng Zhang  1   3 , Houchen Lyu  1   3 , Peifu Tang  1   3
Affiliations

Preoperative Anemia and Risk of In-hospital Postoperative Complications in Patients with Hip Fracture

Yu Jiang et al. Clin Interv Aging. .

Abstract

Purpose: To evaluate the impact of preoperative anemia on postoperative complications after hip fracture surgery.

Patients and methods: 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.

Results: 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).

Conclusion: 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.

Keywords: anemia; hip fracture; postoperative complications; risk factor.

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Conflict of interest statement

All authors declare no conflicts of interest that could bias this work.

Figures

Figure 1
Figure 1
Selection process of the study population.
Figure 2
Figure 2
Frequency of major complications in anemic and non-anemic patients after hip fracture surgery.
Figure 3
Figure 3
Risk (per 1000 persons) of major complications in anemic and non-anemic patients after hip fracture surgery, stratified by the frequency of complications.
See this image and copyright information in PMC

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