Anaemia impedes functional mobility after hip fracture surgery.
BACKGROUND
the impact of anaemia on the outcome after a hip fracture surgery is controversial, but anaemia can potentially decrease the physical performance and thereby impede post-operative rehabilitation. We therefore conducted a prospective study to establish whether anaemia affected functional mobility in the early post-operative phase after a hip fracture surgery.


METHODS
four hundred and eighty seven consecutive hip fracture patients, treated according to a well-defined multimodal rehabilitation programme with a uniform, liberal transfusion threshold, were studied. Hb was measured on each of the first three post-operative days, and anaemia defined as Hb <100 g/l. Functional mobility was measured with the Cumulated Ambulation Score (CAS).


RESULTS
the results were obtained from 170, 132 and 116 patients who were found anaemic on the first, second and third post-operative day, respectively. A significant association between anaemia and the ability to walk independently before the correction of anaemia was present on each of the 3 days separately (P<0.05). A significant correlation was also found on each day between the functional score and the Hb level. A multivariate analysis integrating the type of surgery, medical complications and prefracture function showed that anaemia at the time of the physiotherapy session was an independent risk factor for not being able to walk on the third post-operative day [OR 0.41 (0.14-0.73) P = 0.002].


CONCLUSIONS
anaemia impedes functional mobility in the early post-operative phase after a hip fracture surgery and is an independent risk factor for patients not being able to walk post-operatively. The potential for a liberal transfusion policy to improve the rehabilitation potential in hip fracture patients with anaemia should be investigated.
Foss
Nicolai B
NB
Department of Anaesthesia, Hvidovre University Hospital, Hvidovre, Denmark. nbf@comxnet.dk
Kristensen
Morten Tange
MT
Kehlet
Henrik
H
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D001803:Blood Transfusion; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006454:Hemoglobins / Q000032:analysis; D006620:Hip Fractures / Q000401:mortality / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods; D026741:Physical Therapy Modalities; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D015996:Survival Rate; D016138:Walking / Q000502:physiology
D006454:Hemoglobins