Association between preoperative hemoglobin levels and postoperative functional recovery in tibial plateau fractures: a prospective cohort study

BACKGROUND: The relationship between preoperative hemoglobin levels and postoperative functional recovery in patients with tibial plateau fractures has not been fully investigated. This study aimed to explore the correlation between preoperative hemoglobin levels and postoperative functional recovery. METHODS: Patients admitted with tibial plateau fractures between January 2014 and December 2023 were included in this study, and patient data were prospectively collected through follow-up. The indicator of interest in this study was preoperative hemoglobin level, and the primary outcome was the Oxford Knee Score (OKS). Restricted cubic splines (RCS) were used to assess the dose-response relationship between preoperative hemoglobin levels and postoperative functional recovery. Propensity score matching was performed to reduce confounding factors, and multivariate logistic regression analysis was used to evaluate the association between preoperative hemoglobin levels and postoperative functional recovery. Subgroup analyses were conducted to identify potential population heterogeneity and test the robustness of the results. RESULTS: The study found a significant nonlinear relationship between preoperative hemoglobin levels and postoperative functional scores: the adjusted RCS showed a "U"-shaped curve trend, with an initial decrease followed by an increase as preoperative hemoglobin levels increased. After propensity score matching, the analysis showed that the proportion of poor postoperative function in the overweight group was significantly higher than that in the within-weight group (18.22% vs 6.28%), with OR = 3.33 (P < 0.001), indicating that abnormal preoperative hemoglobin levels were an independent risk factor for poor functional recovery after tibial plateau fracture. Subgroup analyses further confirmed that this association remained stable across different subgroups (P > 0.05), indicating the broad applicability and robustness of this risk relationship. CONCLUSION: Preoperative hemoglobin levels >147.9 or