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Elderly/Long-term Care

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Transfusion after hip fracture surgery reduces the risk of rehospitalization for older patients with significant anemia

Older patients who receive blood transfusions after surgery for hip fracture are less likely to be readmitted to the hospital, according to a study supported by the Agency for Healthcare Research and Quality (HS09973 and HS09459). A research team led by Ethan A. Halm, M.D., M.P.H., and Albert Sui, M.D., M.S.P.H., of Mount Sinai School of Medicine, prospectively studied the effects of blood transfusion on clinical and functional outcomes of 551 patients older than 50 who underwent surgery for hip fracture at one of four hospitals.

Low level anemia is a hemoglobin (Hb) concentration of 10 to 11.5 g/dL; normal Hb is 12-16 g/dL for women and 14-18 g/dL for men. The researchers defined the trigger Hb level as the lowest value before the first postoperative transfusion. Overall, 54 percent of patients received transfusions at any time during their hip fracture hospitalization. Nearly three-fourths (72 percent) of patients with a lowest postoperative Hb level of less than 10 g/dL (significant anemia) received transfusions compared with nearly 20 percent of those whose lowest measurement was at least 10 g/dL (traditional transfusion threshold). In the 60 days after discharge, 4 percent of patients died, and 17 percent were readmitted to the hospital.

Transfusion was associated with a 48 percent reduction in the odds of readmission for patients with a trigger Hb level of less than 10 g/dL, but it did not influence patients' mortality or mobility functioning (ability to walk and climb stairs). For patients with a trigger Hb level of at least 10 g/dL, transfusion did not affect rates of death or readmission, but it was associated with better functional mobility scores. It may be that only significant anemia (Hb less than 10 g/dL) influences the likelihood of subsequent deterioration serious enough to prompt rehospitalization, suggest the researchers.

See "Effects of blood transfusion on clinical and functional outcomes in patients with hip fracture," by Dr. Halm, Jason J. Wang, M.A., M.S., Kenneth Boockvar, M.D., M.S., and others, in the October 2003 Transfusion 43, pp. 1358-1365.

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