Preoperative Hemoglobin Decline Is Not an Independent Prognostic Factor for Mortality in Older Hip Fracture Patients.

Authors

Nadav Graif, Lera Sotnikov, Yaniv Warschawski, Nissan Amzallag, Lior Shabtai, Morsi Khashan, Gil Rachevski, Itay Ashkenazi

Published in

Geriatrics & gerontology international. Volume 26. Issue 7. Pages e70630.

Abstract

To evaluate whether preoperative hemoglobin (Hb) decline independently predicts mortality in older hip fracture patients and whether commonly used Hb-drop thresholds add prognostic value beyond established clinical risk factors.
We performed a retrospective cohort study of consecutive patients aged ≥ 65 years undergoing surgery for acute hip fracture at a level I trauma center (2019-2024). Preoperative Hb drop was defined as the difference between emergency department admission Hb and pre-anesthesia Hb. Six Hb-drop thresholds (≥ 1.0, ≥ 1.5, ≥ 2.0, ≥ 2.5, ≥ 3.0, ≥ 4.0 g/dL) were evaluated. The primary outcome was 30-day all-cause mortality; secondary outcomes included 7-day, 90-day, 6-month, and 1-year mortality. Multivariate logistic regression for each threshold adjusted for age ≥ 85 years, ASA class ≥ 3, chronic kidney disease, and admission Hb < 10 g/dL.
Among 1832 patients (mean age 82.6 ± 8.0 years; 65.8% women), 30-day mortality was 4.3% (78/1832). A preoperative Hb drop ≥ 2 g/dL occurred in 49.3% of patients, with similar prevalence among survivors and non-survivors (49.2% vs. 51.3%, p = 0.734). No Hb-drop threshold was independently associated with 30-day mortality (all p > 0.05); for the ≥ 2 g/dL threshold, adjusted odds ratio (OR) was 1.08 (95% CI 0.66-1.77, p = 0.757). In contrast, age ≥ 85 years (adjusted OR 3.39, 95% CI 1.98-5.79, p < 0.001) and ASA ≥ 3 (adjusted OR 2.02, 95% CI 1.08-3.78, p = 0.029) were independently associated with 30-day mortality. No Hb-drop threshold showed an independent association with mortality at any timepoint (7-day, 90-day, 6-month, 1-year).
In older hip fracture patients, preoperative Hb decline-including the widely used ≥ 2 g/dL threshold-was not an independent prognostic factor for mortality. Admission-available clinical factors are more informative for short-term mortality risk assessment than the preoperative Hb drop in this population.

PMID:
42390274
Bibliographic data and abstract were imported from PubMed on 02 Jul 2026.

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