Blood transfusion requirements in elderly hip fracture patients

The purpose of this study was to investigate blood transfusion patterns in elderly hip fractured patients and to determine the clinical predictive criteria for blood utilization. This retrospective study involved data analysis of 302 patients, undergoing surgical repair of pertrochanteric and subcapital fractures. Patients of the transfused group had significantly lower admission hemoglobin (P<0.0001) and significantly more pertrochanteric fractures. About 80% of patients of the lowermost quartile of admission hemoglobin were transfused, compared with <20% of the uppermost group (P<0.0001). Admission hemoglobin levels <12 g% and pertrochanteric fractures were independently associated with transfusions (odds ratio (O.R.) 0.475, C.I. 0.377-0.598, P<0.0001 and O.R. 1.885, C.I. 1.05-3.215, P=0.02, respectively). The results support the adoption of a policy considering primarily these two factors. Other factors we studied had no predictive power. Cross-matching may be reserved only for patients presenting with hemoglobin <12 g% and pertrochanteric fractures. This practice seems safe and should help in reducing the extent of unnecessary blood ordering.