What role does blood transfusion play in early infection risk for elderly patients with fractures of the proximal extremity of the femur treated surgically? A single center cohort study.

BACKGROUND

Early surgical site infection (SSI) is a serious complication following proximal femoral fracture surgery in elderly patients. Perioperative blood transfusion has been suggested as a potential contributor to postoperative infection through immunomodulatory mechanisms, but evidence in geriatric trauma populations remains limited. This study evaluated the association between perioperative blood transfusion and early SSI in elderly patients undergoing surgery for proximal femoral fracture.

HYPOTHESIS: Perioperative transfusion of labile blood products is associated with an increased risk of early SSI after hip fracture surgery in elderly patients.

MATERIALS AND

METHODS

We conducted a retrospective single-center cohort study including 861 consecutive patients aged ≥65 years who underwent surgery for proximal femoral fracture. The primary outcome was early SSI occurring within 30 days postoperatively. Perioperative transfusion was defined as the administration of at least one unit of allogeneic packed red blood cells during hospitalization. Risk factors were analyzed using univariate and multivariable penalized logistic regression (Firth's method) due to the low number of events.

RESULTS

Sixteen early SSIs (1.9%) were identified. In univariate analysis, perioperative transfusion, active smoking, obesity, history of malignancy, transfusion ≥3 units, operative time, and length of hospital stay were associated with infection. In multivariable analysis, perioperative transfusion (OR 1.50 per unit; 95% CI 1.18-1.87; p = 0.002), active smoking (OR 6.82; p = 0.002), and operative time (OR 1.04 per minute; p < 0.001) remained independently associated with early SSI.

DISCUSSION: Perioperative transfusion was independently associated with early SSI in this elderly hip fracture population. Operative time and active smoking were also independent predictors. These findings suggest that optimization of blood management strategies and surgical duration may represent modifiable targets to reduce infectious complications. Larger prospective multicenter studies are required to confirm these results.

LEVEL OF EVIDENCE: III; retrospective cohort study.