Is anemia at admission related to short-term outcomes of elderly hip fracture patients?

• Authors: Emilija Dubljanin-Raspopović , Ljiljana Marković-Denić , Dejan Nikolić , Goran Tulić , Marko Kadija , Marko Bumbaširević
• Languages of publication: EN

Abstracts

EN

Hip fracture in elderly people is associated with high morbidity and mortality. Therefore, it is important to identify risk factors that potentially influence outcomes after hip surgery. The main purpose of this study was to evaluate the relationship of anemia at admission and short-term outcomes after hip fracture. We studied 343 community-dwelling patients who underwent surgery for hip fracture from March 2009 to March 2010. Functional mobility at discharge, postoperative complications, hospital length of stay and in-hospital mortality were analyzed in respect to presence and severity of anemia at admission. Anemia (defined as hemoglobin levels < 13.0 g/dl for men and < 12.0g/dl for women) was present in 185 (53.9%) patients, of whom 54 (29.2%) were severely anemic (defined as hemoglobin level 10.0g/dl or below). In multivariate analysis anemia was associated with age, gender (female), type of fracture (intertrochanteric) and American Society of Anesthesiologists (ASA) classification (3 or 4), while severity of anemia was associated with recovery of ambulatory ability at discharge. There was no difference in the incidence of postoperative complication, in-hospital mortality and length of hospital stay between the groups at discharge. Overall anemia at admission is an indicator of poor general health status. Ambulatory recovery in hip fracture patients is independently related to severity of anemia at admission.

Keywords

EN

Hemoglobin; Rehabilitation; Functional recovery

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2011
• Volume: 6
• Issue: 4
• Pages: 483-489

Dates

published

1 - 8 - 2011

online

1 - 6 - 2011

Contributors

author

Emilija Dubljanin-Raspopović

author

Ljiljana Marković-Denić

• Institute of Epidemiology, School of Medicine, Belgrade University, Belgrade, Serbia

author

Dejan Nikolić

• University Childrens Hospital, Belgrade, Serbia

author

Goran Tulić

author

Marko Kadija

author

Marko Bumbaširević

References

• [1] World Health Organization, aging and life course [http://www.who.int/aging/en]
• [2] Peters R, Burch L, Warner J, Beckett N, Poulter N, Bulpitt C. Haemoglobin, anaemia, dementia and cognitive decline in the elderly, a systematic review. BMC Geriatr 2008; 8:18 http://dx.doi.org/10.1186/1471-2318-8-18[Crossref]
• [3] Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int 1997; 7:407–413 http://dx.doi.org/10.1007/PL00004148[Crossref]
• [4] Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int 1992; 2:285–289 http://dx.doi.org/10.1007/BF01623184
• [5] Barrett-Connor E. The economic and human costs of osteoporotic fracture. Am J Med 1995; 98:3S–8S http://dx.doi.org/10.1016/S0002-9343(05)80037-3[Crossref]
• [6] Schneider EL, Guralnick JM. The aging of America: impact on health care costs. JAMA 1990; 263:2335–2340 http://dx.doi.org/10.1001/jama.263.17.2335[Crossref]
• [7] Gaskell H, Derry S, Andrew Moore R, McQuay HJ. Prevalence of anemia in older persons: systematic review. BMC Geriatr 2008; 8:1 http://dx.doi.org/10.1186/1471-2318-8-1[Crossref]
• [8] Al-Ani AN, Flodin L, Söderqvist A, et al. Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients. Arch Phys Med Rehabil 2010; 91: 51–57 http://dx.doi.org/10.1016/j.apmr.2009.09.005[WoS][Crossref]
• [9] Givens JL, Sanft TB, Marcantonio ER. Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. J Am Geriatr Soc 2008; 56:1075–1079 http://dx.doi.org/10.1111/j.1532-5415.2008.01711.x[Crossref]
• [10] Feng M, Zhang J, Shen H, Hu H, Cao L. Predictors of prognosis for elderly patients with poststroke hemiplegia experiencing hip fractures. Clin Orthop Relat Res 2009; 467:2970–2978 http://dx.doi.org/10.1007/s11999-009-0835-5[Crossref]
• [11] Foss NB, Kristensen MT, Kehlet H. Anaemia impedes functional mobility after hip fracture surgery. Age Ageing. 2008; 37:173–178 http://dx.doi.org/10.1093/ageing/afm161[Crossref][WoS]
• [12] Lawrence VA, Silverstein JH, Cornell JE, Pederson T, Noveck H, Carson JL. Higher Hb level is associated with better early functional recovery after hip fracture repair. Transfusion 2003; 43:1717–1722 http://dx.doi.org/10.1046/j.0041-1132.2003.00581.x[Crossref]
• [13] Su H, Aharonoff GB, Zuckerman JD, Egol KA, Koval KJ. The relation between discharge hemoglobin and outcome after hip fracture. Am J Orthop (Belle Mead NJ) 2004; 33:576–580
• [14] Adunsky A, Arad M, Blumstein T, Weitzman A, Mizrahi EH. Discharge hemoglobin and functional outcome of elderly hip fractured patients undergoing rehabilitation. Eur J Phys Rehabil Med 2008; 44:417–422 [PubMed]
• [15] Gruson KI, Aharonoff GB, Egol KA, Zuckerman JD, Koval KJ. The relationship between admission hemoglobin level and outcome after hip fracture. J Orthop Trauma 2002; 16:39–44 http://dx.doi.org/10.1097/00005131-200201000-00009[Crossref]
• [16] Halm EA, Wang JJ, Boockvar K, et al. The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture. J Orthop Trauma 2004; 18:369–374 http://dx.doi.org/10.1097/00005131-200407000-00007[Crossref]
• [17] Hagino T, Ochiai S, Sato E, Maekawa S, Wako M, Haro H. The relationship between anemia at admission and outcome in patients older than 60 years with hip fracture. J Orthop Traumatol 2009; 10:119–122 http://dx.doi.org/10.1007/s10195-009-0060-8[Crossref]
• [18] Carson JL, Duff A, Berlin JA, et al. Perioperative blood transfusion and postoperative mortality. JAMA 1998; 279:199–205 http://dx.doi.org/10.1001/jama.279.3.199[Crossref]
• [19] Poses RM, Berlin JA, Noveck H, et al. How you look determines what you find: severity of illness and variation in blood transfusion for hip fracture. Am J Med 1998; 105:198–206 http://dx.doi.org/10.1016/S0002-9343(98)00236-8[Crossref]
• [20] Adunsky A, Lichtenstein A, Mizrahi E, Arad M, Heim M. Blood transfusion requirements in elderly hip fracture patients. Arch Gerontol Geriatr 2003; 36:75–81 http://dx.doi.org/10.1016/S0167-4943(02)00059-6[Crossref]
• [21] World Medical Association DoH. Helsinki declaration. http://www.wma.net/en/30publications/10policies/b3/index.html]
• [22] Koval K, Intertrochanteric fractures, In: Bucholz R., Heckman J., Court-Brown C. (Eds.), Fractures in Adults, 6th ed, Lippincott Williams & Wilkins, Philadelphia, 2006
• [23] Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of Illness in the Aged. The Index of ADL: A Standardized Measure of Biological and Psychosocial Function. JAMA 1963; 185:914–919
• [24] Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978; 49:239–243 http://dx.doi.org/10.1097/00000542-197810000-00003[Crossref]
• [25] Paksima N, Koval KJ, Aharanoff G, et al. Predictors of mortality after hip fracture: a 10-year prospective study. Bull NYU Hosp Jt Dis 2008; 66:111–117
• [26] Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD. Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res 1995; 310:150–159
• [27] Koval KJ, Aharonoff GB, Su ET, Zuckerman JD. Effect of acute inpatient rehabilitation on outcome after fracture of the femoral neck or intertrochanteric fracture. J Bone Joint Surg Am 1998; 80:357–364 [PubMed]
• [28] Brooks R. EuroQol: the current state of play. Health Policy 1996; 37(1):53–72. http://dx.doi.org/10.1016/0168-8510(96)00822-6[Crossref]
• [29] Granger CV, Hamilton BB, Keith RA, Zielezny M, Sherwin F. Advances in functional assessment for medical rehabilitation. In: Lewis CB, editor. Topics in geriatric rehabilitation. Baltimore: Aspen Publishing; 1986, p. 59–74
• [30] World Health Organisation: Nutritional anemia: report of a WHO Scientific Group. Geneva, Switzerland: World Health Organisation; 1968
• [31] Cesari M, Penninx BW, Lauretani F, et al. Hemoglobin levels and skeletal muscle: results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2004; 59:249–254 [Crossref][PubMed]
• [32] Odumala AO, Ayekoloye CI, Packer G. Predictors of excessive blood loss during operative treatment of hip fractures. J R Coll Surg Edinb 2002; 47:552–556
• [33] Committee for Osteoporosis Treatment of The Japanese Orthopaedic Association. Nationwide survey of hip fractures in Japan. J Orthop Sci 2004;9(1):1–5 http://dx.doi.org/10.1007/s00776-003-0741-8[Crossref]
• [34] Dharmarajan TS, Avula S, Norkus EP. Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients. J Am Med Dir Assoc 2007;8(3 Suppl 2):e9–e15 http://dx.doi.org/10.1016/j.jamda.2006.12.015[Crossref]
• [35] Duke RG, Keating JL. An investigation of factors predictive of independence in transfers and ambulation after hip fracture. Arch Phys Med 2002; 83:158–164 http://dx.doi.org/10.1053/apmr.2002.27463[Crossref]

Identifiers

DOI

10.2478/s11536-011-0031-3