Curative efficacy of strengthen transfusion strategy for older patients with hip fracture: A Single-center Retrospective Study

Background: Perioperative transfusion is very common in older patients with hip fracture, but there is still great controversy about whether patients with hemoglobin (Hb) value between 90-100g/L should receive transfusion. The aim of this retrospective study was to observe the curative efficacy of strengthen transfusion strategy for hip fracture patients of age≥65 years. Methods: A retrospective analysis was made on elderly patients with hip fracture who were treated in a single trauma emergency center from 2015 to 2019. Patients who received surgical treatment and had perioperative transfusion records were selected and were divided into three groups according to the lowest perioperative Hb value of 70-80g/L, 80-90g/L and 90-100g/L. According to whether to continue transfusion when the Hb value is between 90-100g/L, they were divided into strengthen transfusion strategy group or routine transfusion strategy group. The demographic data (gender, age, fracture type, complications, etc.), the Hb value, red blood (RBC)use, and patient outcomes between the two groups were analyzed . Results: In total, 4966 elderly hip fracture patients were identified of whom 22.0% had documented perioperative transfusion. After screening the inclusion and exclusion criteria, a total of 802 patients were included in our study, including 95 in the 70-80g /L group, 264 in the 80-90g /L group and 443 in the 90-100g /L group. There was no significant difference in hospital stay between strengthen and routine transfusion group, however strengthen transfusion strategy can reduce the incidence of perioperative pulmonary infection and cerebral infarction in each group. And it can also reduce the incidence of arrhythmia, urinary tract infection in 80-90g /L group and electrolyte disorder in 90-100g /L group, respectively. Conclusions: For elderly patients with hip fracture, strengthen transfusion strategy does not increase the risk of perioperative major adverse coronary events (MACE), reduce the incidence of adverse outcomes such as perioperative pulmonary infection, cerebral infarction and shorten the length of hospital stay.