The effects of 'old' red blood cell transfusion on mortality and morbidity in elderly patients with hip fractures-A retrospective study

Background: Elderly patients admitted with hip fractures often receive allogenic blood transfusion (ABT) in the perioperative period. We examined the effect of the shelf life of the ABT on mortality and morbidity. Methods: A total of 1381 patients with hip fractures were retrospectively analysed. Two groups were compared, group A ('new'), with an ABT shelf life ≤ 14 days, and group B ('old'), with an ABT shelf life > 14 days. Data collected for both groups included general demographic data, data regarding postoperative infections and other complications rates and data regarding mortality. Kaplan-Meier curves were used to assess difference in survival between the groups. Cox regression was performed to analyse the survival after controlling for age, sex, pre-surgical haemoglobin concentration, pre-surgical creatinine, American Society of Anesthesiologists (ASA) score, surgery type and number of blood units given. Results: Higher mortality was seen in hip fracture patients who received 'old' blood unit compared to 'new' blood unit but the difference was not statistically significant (P = 0.5). Cox regression model demonstrated that designation into either young or old groups was not associated with mortality (hazard ratio: 1.14 (confidence interval: 0.85-1.53)). No differences were noted between the groups with regard to infection and other postoperative complication rates. Conclusion: Patients undergoing surgery for hip fractures who received 'old' units of blood did not differ from those receiving 'new' units with regard to mortality and morbidity. Large-scale clinical trials are needed to further investigate this association.