Risk Factors for Post-Operative Blood Transfusion and Association with Outcomes in Hip Fracture Surgery

Lou’i Al-Husinat,1 Fadi Haddad,2 Sarah Al Sharie,3 Mohammad Araydah,4 Laith Al Hseinat,5 Mohamad Kharashgah,1 Adel Alsharei,1 Zaid AL Modanat,1 Mohammed S Alisi,6 Jihad Al-Ajlouni,7 Mohd Said Dawod,8 Silvia De Rosa,9,10,* Denise Battaglini11,12,* 1Department of General Surgery and Anesthesia, Faculty of Medicine, Yarmouk University, Irbid, Jordan; 2Department of Internal Medicine, Trinity Health Oakland, Pontiac, MI, USA; 3Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan; 4Department of Internal Medicine, Istishari Hospital, Amman, Jordan; 5Department of Orthopaedics, Royal Medical Services, Amman, Jordan; 6Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine; 7Department of Special Surgery, College of Medicine, Mutah University, Al-Karak, Jordan; 8Department of Orthopedic Surgery, School of Medicine, University of Jordan, Amman, Jordan; 9Centre for Medical Sciences - Cismed, University of Trento, Trento, Italy; 10Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, Trento, Italy; 11Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genova, Italy; 12Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy*These authors contributed equally to this workCorrespondence: Lou’i Al-Husinat, Department of General Surgery and Anesthesia, Faculty of Medicine, Yarmouk University, Irbid, Jordan, Email loui.husinat@yu.edu.joBackground: Blood transfusion during hip fracture surgery can significantly influence patient outcomes. This study aimed to identify risk factors for post-operative blood transfusions and their impact on clinical outcomes, including all-cause mortality.Methods: A post-hoc analysis was conducted on data from a multicentric observational study in Jordan. Demographics, preoperative variables, intraoperative details, and postoperative outcomes were analyzed. Logistic regression identified risk factors for transfusions, and Cox proportional hazards models assessed associations with mortality.Results: The study included 1040 patients who underwent hip fracture repair (35.87% received transfusion and 64.13% did not receive transfusion). Patients who received transfusion were older (median age 79 vs 77 years, p=0.0015), more frequently females (60.59%), and had lower preoperative hemoglobin levels (10.85± 1.75 vs 12.62± 1.61 g/dL, p< 0.001). Clopidogrel use (10.99% vs 6%, p=0.004), unstable intertrochanteric fractures (53.08% vs 42.13%, p=0.001), and ICU admissions (19.03% vs 6.45%; p< 0.001) were significantly more common in patients who received transfusion. Transfused patients experienced longer hospital stays (median 7 [IQR=5– 10] vs 6 [IQR=4– 8] days, p< 0.001), higher readmission rates (13.4% vs 8.85%; p=0.021), and increased all-cause mortality (18.23% vs 11.24%; p=0.002). However, this observed increase in mortality did not remain significant after multivariate adjustment. At multivariate analysis, blood transfusion was independently associated with ICU admission (OR=2.17, 95% CI=1.28– 3.66,p=0.004), and longer hospital stay (OR=1.05, 95% CI=1.02– 1.09, p=0.005), while no independent association between blood transfusion and all-cause mortality was found (HR=1.15, 95% CI=0.79– 1.66, p=0.465).Conclusion: Blood transfusion in hip fracture surgery are linked to longer hospital stay and ICU admission, but not to increased all-cause mortality. Careful management of hemoglobin levels and transfusion practices is crucial.Keywords: anemia, hip fractures/surgery, blood transfusion, postoperative outcomes, retrospective studies