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KMID : 0191120200350370313
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Journal of Korean Medical Science
2020 Volume.35 No. 37 p.313 ~ p.313
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Blood Transfusion for Elderly Patients with Hip Fracture: a Nationwide Cohort Study
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Jang Suk-Yong
Cha Yong-Han
Yoo Jun-Il
Oh Tae-Ho
Kim Jung-Taek
Park Chan-Ho
Choy Won-Sik
Ha Yong-Chan
Koo Kyung-Hoi
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Abstract
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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.
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KEYWORD
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Blood Transfusion, Elderly, Hip Fracture, Mortality, Packed Red Blood Cells
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