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Blood Transfusion for Elderly Patients with Hip Fracture: a Nationwide Cohort Study

Journal of Korean Medical Science 2020년 35권 37호 p.313 ~ 313
장석용, 차용한, 유준일, 오태호, 김정택, 박찬호, 최원식, 하용찬, 구경회,
소속 상세정보
장석용 ( Jang Suk-Yong ) - Eulji University School of Medicine Department of Preventive Medicine
차용한 ( Cha Yong-Han ) - Eulji University Hospital Department of Orthopaedic Surgery
유준일 ( Yoo Jun-Il ) - Gyeongsang National University Hospital Department of Orthopaedic Surgery
오태호 ( Oh Tae-Ho ) - Eulji University Hospital Department of Orthopaedic Surgery
김정택 ( Kim Jung-Taek ) - Ajou University Medical Center Department of Orthopedic Surgery
박찬호 ( Park Chan-Ho ) - Yeungnam University Medical Center Department of Orthopaedic Surgery
최원식 ( Choy Won-Sik ) - Eulji University Hospital Department of Orthopaedic Surgery
하용찬 ( Ha Yong-Chan ) - Chung-Ang University College of Medicine Department of Orthopaedic Surgery
구경회 ( Koo Kyung-Hoi ) - Seoul National University Bundang Hospital Department of Orthopaedic Surgery

Abstract


Background: This nationwide study aimed to investigate the blood transfusion status of elderly hip fracture patients and to examine the effect of packed red blood cell transfusion on all-cause mortality.

Methods: From the Korean National Health Insurance Service-Senior cohort consisting of 588,147 participants aged over 60 years in 2002, a total of 14,744 new-onset hip fracture patients aged 65?99 years were followed up for 11 years. The adjusted hazard ratios (aHRs), risk ratios, and their 95% confidence intervals were estimated by the Cox proportional hazard model and Poisson regression model.

Results: There were 10,973 patients (74.42%) in the transfusion group and 3,771 (25.58%) patients in the non-transfusion group. The mean volume of blood transfusion was 1,164.51 mL (± 865.25; median, 800 mL; interquartile range, 640?1,440). In the multivariable-adjusted Cox proportional hazard model, the transfusion group had 1.34-fold more risk of all-cause mortality than the non-transfusion group (aHR, 1.34; 95% confidence interval [CI], 1.26?1.42). In the multivariate-adjusted Poisson regression model, hip fracture patients in the transfusion group were 1.43 (adjusted risk ratio [aRR], 1.43; 95% CI, 1.09?1.87; P = 0.009) folds more likely to die within 30 days than those in the non-transfusion group. The mortality risk was highest at 90 days (aRR, 1.64; 95% CI, 1.40?1.93; P < 0.001) and slightly decreased at 180 days (aRR, 1.58; 95% CI, 1.40?1.79; P < 0.001) and 1 year (aRR, 1.43; 95% CI, 1.31?1.58; P < 0.001).

Conclusion: In this nationwide representative cohort study, blood transfusion was performed in 75% of hip fracture patients. Even after adjusting for comorbidity and anticoagulant use, the postoperative results (hospitalization, mortality) of the transfusion group did not show significantly worse results than the non-transfusion group. Therefore, adequate patient blood management can only improve the patient's outcome after hip fracture surgery.

키워드

Blood Transfusion; Elderly; Hip Fracture; Mortality; Packed Red Blood Cells

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