Is perioperative blood transfusion a risk factor for mortality or infection after hip fracture?

Objectives: To assess whether allogeneic blood transfusion in the perioperative period is associated with changes in mortality or complication rates in patients undergoing surgical treatment for hip fracture (proximal femoral fracture). Design: Retrospective case-control series, all patients followed up for 1 year or until death. Setting: District General Hospital in Peterborough, UK. Patients Participants: Three thousand six hundred twenty-five consecutive patients admitted and operated for hip fracture (proximal femoral fracture) during July 1989 to January 2002 (151 months); 1068 (29.9%) received a perioperative allogeneic blood transfusion. Main Outcome Measures: Thirty- 120-, and 365-day mortality, deep and superficial wound infection rates. Results: Overall mortality for all patients at 1 year post fracture was 28.2% (1007 patients). Transfusion was associated with a statistically significant increase in mortality from 120 days onward after hip fracture. However, when this was adjusted with a statistical regression model for baseline characteristics and confounding variables, this difference became statistically insignificant (P = 0.17). Infection rates in the transfusion group were 2.0% for superficial infection and 0.9% for deep infection compared with 1.9% and 0.6%, respectively, in the nontransfusion group. These figures were not statistically significantly different. Other complications of deep venous thrombosis, chest infection, and congestive cardiac failure showed no statistically significant increase in those patients who received transfusion. Conclusions: Our data suggest that transfusion is not associated with a change in mortality or infection rates in the hip-fracture patient.