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Body mass index, risk of allogeneic red blood cell transfusion, and mortality in elderly patients undergoing hip fracture surgery

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Abstract

Summary

Despite improvements in preoperative and postoperative treatment, hip fracture surgery may lead to blood transfusion. Little is known about the impact of body mass index on transfusion risk and subsequent mortality. Opposite overweight and obese patients, underweight patients had increased risk of transfusion and death within 1 year of surgery.

Introduction

Despite improvements in preoperative and postoperative treatment of hip fracture patients, hip fracture surgery may lead to blood loss. We examined the risk of red blood cell transfusion (as an indirect measure of blood loss) and subsequent mortality by body mass index level in patients aged 65 and over undergoing hip fracture surgery.

Methods

This is a population-based cohort study using medical databases. We included all patients who underwent surgery for hip fracture during 2005–2013. We calculated the cumulative risk of red blood cell transfusion within 7 days of surgery treating death as a competing risk and, among transfused patients, short- (8–30 days postsurgery) and long-term mortality (31–365 days postsurgery).

Results

Among 56,420 patients, 47.7 % received at least one red blood cell transfusion within 7 days of surgery. In patients with normal weight, the risk was 48.8 % compared with 57.0 % in underweight patients (adjusted RR = 1.11; CI 1.08–1.15), 42.1 % in overweight patients (adjusted RR = 0.89; CI 0.86–0.91), and 42.2 % in obese patients (adjusted RR = 0.87; CI 0.84–0.91). Among transfused patients, adjusted HRs for short-term mortality were 1.52 (CI 1.34–1.71), 0.70 (CI 0.61–0.80), and 0.58 (CI 0.43–0.77) for underweight, overweight, and obese patients, respectively, compared with normal-weight patients. The corresponding adjusted HRs for long-term mortality were 1.45 (CI 1.33–1.57), 0.80 (CI 0.74–0.86), and 0.58 (CI 0.50–0.69). Similar association between BMI and mortality was observed also among non-transfused patients.

Conclusions

Underweight patients had a higher risk of red blood cell transfusion and death in the first year of surgery than normal-weight patients, even when controlling for age and comorbidity. Opposite findings were seen for overweight and obese patients.

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Acknowledgments

The authors wish to thank the orthopedic surgeons and other healthcare professionals at all hospitals in Denmark for cooperation regarding the data registration in Danish national registries.

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Authors and Affiliations

  1. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark

    A. B. Pedersen, D. Cronin Fenton, M. Nørgaard & N. R. Kristensen

  2. Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    B. Kuno Møller & C. Erikstrup

Authors
  1. A. B. Pedersen
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  2. D. Cronin Fenton
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  3. M. Nørgaard
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  4. N. R. Kristensen
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  5. B. Kuno Møller
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  6. C. Erikstrup
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Corresponding author

Correspondence to A. B. Pedersen.

Ethics declarations

The study was approved by the Danish Data Protection Agency (Jr. number 2014-41-2803). Permission for using data from the DHFD, including comorbidity and vital status data, as well as data from the DTDB was obtained from Danish Data Protection Agency (Jr. number 2014-331-0769).

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Pedersen, A.B., Cronin Fenton, D., Nørgaard, M. et al. Body mass index, risk of allogeneic red blood cell transfusion, and mortality in elderly patients undergoing hip fracture surgery. Osteoporos Int 27, 2765–2775 (2016). https://doi.org/10.1007/s00198-016-3594-7

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