The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture.
OBJECTIVE
To describe the epidemiology of perioperative anemia in patients with hip fracture and assess the relationship between the hemoglobin measurements and clinical outcomes.


METHODS
Prospective observational cohort study.


METHODS
Four university and community teaching hospitals.


METHODS
A consecutive cohort of 550 patients who underwent surgery for hip fracture and survived to discharge from August 1997 and August 1998 were evaluated and followed prospectively.


METHODS
Deaths, readmissions and Functional Independence Motor mobility scores within 60 days of discharge.


RESULTS
Anemia (defined as hemoglobin <12.0 g/dL) was present in 40.4% of patients on admission, 45.6% at the presurgery nadir, 93.0% at the postsurgery nadir, and 84.6% near discharge. The mean drop in hemoglobin after surgery was 2.8 +/- 1.6 g/dL. In multivariate analyses, higher hemoglobin levels on admission were associated with shorter lengths of hospital stay and lower odds of death and readmission even after controlling for a broad range of prefracture patient characteristics, clinical status on discharge, and use of blood transfusion. Admission and preoperative anemia was not associated with risk-adjusted Functional Independence Motor mobility scores. In multivariable analyses, higher postoperative hemoglobin was associated with shorter length of stay and lower readmission rates, but did not effect rates of death or Functional Independence Motor mobility scores.


CONCLUSIONS
Substantial declines in hemoglobin were common in patients with hip fracture. Higher preoperative hemoglobin was associated with shorter length of stay and lower odds of death and readmission within 60 days of discharge. Postoperative hemoglobin was also related to length of stay and readmission rates.
Halm
Ethan A
EA
Department of Health Policy, Mount Sinai School of Medicine, New York, NY 10029, USA. ethan.halm@mountsinai.org
Wang
Jason J
JJ
Boockvar
Kenneth
K
Penrod
Joan
J
Silberzweig
Stacey B
SB
Magaziner
Jay
J
Koval
Kenneth J
KJ
Siu
Albert L
AL
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006620:Hip Fractures / Q000097:blood / Q000150:complications* / Q000601:surgery; D006621:Hip Joint / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome; D016138:Walking
D006454:Hemoglobins