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

AIM: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.