Postoperative hemoglobin predicts hospital stay after hip fracture surgery

Postoperative anemia is associated with longer hospital stays following surgery for hip fracture, Dutch researchers report.

In their study of 317 patients aged 65 years and older who underwent hip fracture surgery during 2004-2006, JorienWillems (Leiden University Medical Centre) and colleagues found that patients with postoperative anemia had a mean hospital stay of 10.7 days, compared with 7.5 days in those without anemia. This was a statistically significant difference.

Anemia was defined as a hemoglobin level at or below 12 g/dL for women and at or below 13 g/dL for men, and was present in 86% of patients after surgery.

The researchers say that the high proportion of patients with anemia results from "stringent blood management guidelines." Most hospitals in the Netherlands advise red blood cell transfusions for patients aged at least 60 years only if their hemoglobin level drops below 8 g/dL or if anemia is symptomatic.

Willem and co-authors explain that, because hip fracture surgery is associated with considerable blood loss, previous studies have suggested that low perioperative hemoglobin levels are associated with increased morbidity and mortality in older patients.

However, data on the benefits of red cell transfusion after hip fracture surgery are scarce.

The researchers therefore investigated whether higher perioperative hemoglobin levels increase functional recovery and therefore shorten the length of hospital stay after hip fracture surgery.

Linear regression analysis,adjusted for age and gender showed that postoperative hemoglobin level was inversely correlated with hospital stay.

Moreover, patients with no postoperative decrease in hemoglobin levels had a mean hospital stay of 9.2 days compared with a significantly higher 10.3 days for patients with a hemoglobin decrease of more than 3g/dL.

By contrast, length of hospital stay was not associated with preoperative hemoglobin level.

"If a definitive prospective clinical trial demonstrates the same results and causality between higher post-operative haemoglobin levels and post-operative function and length of hospital stay after hip fracture surgery in older persons, current transfusion guidelines would have to be updated," conclude Willems et al in Maturitas.

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