Preoperative Correction of Low Hemoglobin Levels Can Reduce 1-Year All-Cause Mortality in Osteoporotic Hip Fracture Patients: A Retrospective Observational Study

Abstract

Worapaka Manosroi,1 Pichitchai Atthakomol,2,3 Natthanaphop Isaradech,4 Phichayut Phinyo,3,5 Tanawat Vaseenon2 1Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 4Biomedical Informatics Center, Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand; 5Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandCorrespondence: Pichitchai Atthakomol, Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Muang Chiang Mai, Thailand, Tel +66 53 936453 Email p.atthakomol@gmail.comPurpose: Osteoporotic hip fracture surgery is associated with a risk of morbidity and mortality. Admission hemoglobin levels < 10 g/dL have been documented as a strong predictor of mortality risk. This study aimed to investigate the mortality outcome between osteoporotic hip fracture patients who had preoperative hemoglobin levels raised to ≥ 10 g/dL and those with hemoglobin levels were < 10 g/dL.Patients and Methods: This 5-year retrospective observational study included 226 participants with osteoporotic hip fractures that required surgery and who had admission hemoglobin levels < 10 g/dL. Patients were categorized into two groups: those with corrected preoperative hemoglobin ≥ 10 g/dL and those with either corrected or uncorrected preoperative hemoglobin < 10 g/dL. Outcomes were analyzed using Cox proportional hazard regression adjusted for confounders. Results are presented as hazard ratio (HR) and 95% confidence interval (95% CI).Results: Among 226 the patients, the overall mortality rate was 17.25% (n=39/226) of the 226 patients, 93 (41.15%) had their hemoglobin levels raised to ≥ 10 g/dL by red blood cell transfusion. Multivariable analysis after adjustment for confounders showed a 50% lower incidence of mortality among patients with preoperative hemoglobin levels ≥ 10 g/dL than among those with hemoglobin levels < 10 g/dL (HR 0.50, 95% CI (0.25– 0.99), p=0.048).Conclusion: In osteoporotic hip fracture patients with admission hemoglobin < 10g/dL, raising preoperative hemoglobin levels to ≥ 10 g/dL can significantly reduce the risk of mortality. Testing for and correction of low preoperative hemoglobin levels is of value in hip surgery patients.Keywords: osteoporosis, hip fracture, anemia, mortality