People with better balance and mobility following surgery for hip fracture are less likely to be hospitalized, placed in a nursing home, or die. One way to improve early recovery of physical function after hip fracture repair is to treat anemia with transfusions that increase hemoglobin (Hb) concentration during the hospital stay, suggests a study supported in part by the Agency for Healthcare Research and Quality (HS07322). After adjusting for other factors associated with ability to walk, higher average postoperative Hb level was independently associated with the ability to walk a greater distance at the time of hospital discharge.
The researchers analyzed medical record data on 5,793 patients 60 years of age and older (mean age of 79 years) who underwent hip fracture repair at 20 academic and community hospitals between 1982 and 1993. They examined mean postoperative Hb concentration with distance walked at the time of hospital discharge. The predicted distance walked at discharge in feet increased with higher average postoperative Hb levels (7 g/dL, 56 feet; 8 g/dL, 61 feet; 9 g/dL, 67 feet; 10 g/dL, 74 feet; 11 g/dL, 83 feet; 12 g/dL, 92 feet).
Independent predictors of greater distance walked at discharge were higher average postoperative HB and preoperative beta-blocker therapy. Predictors of less distance walked were older age, greater dependence in activities of daily living, neurologic disease, diabetes, and greater comorbidity (coexisting illnesses). These findings suggest that two modifiable factors, higher Hb concentrations and perioperative beta-blockers, may improve functional recovery in elderly patients following surgery and should be confirmed with clinical trials.
See "Higher Hb level is associated with better early functional recovery after hip fracture repair," by Valerie A. Lawrence, M.D., Jeffrey H. Silverstein, M.D., John E. Cornell, Ph.D., and others, in the December 2003 Transfusion 43, pp. 1717-1722.
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