Association between perioperative blood transfusion and 30-day complications in elderly patients undergoing hip fracture surgery: a cohort study

Perioperative blood transfusion (PBT) is a common intervention in elderly patients undergoing hip fracture surgery. However, its association with postoperative complications remains unclear. This study aimed to investigate the relationship between PBT and 30-day complications in elderly patients undergoing hip fracture surgery. This retrospective study was conducted using the clinical database of a tertiary referral center for elderly patients (≥ 60 years) who underwent hip fracture surgery between December 1, 2021, and December 22, 2022. The primary outcome was the incidence of 30-day composite complications, including both major and minor complications following surgery. Multivariate logistic regression was used to assess the association between PBT and outcomes, and the adjusted odds ratios and 95% confidence intervals were calculated. Of the 1,156 included patients (64.8% female; median age 76 years), the 30-day composite complications rates were 36.6% (260 patients) in the PBT group and 23.6% (105 patients) in the non-transfusion group (P < 0.001). In multivariate models, an increased risk of 30-day composite complications in elderly patients undergoing hip fracture surgery was significantly associated with PBT (preoperative only: adjusted odds ratio [aOR], 2.946; 95% confidence interval [CI], 1.519-5.716; intraoperative or postoperative only: aOR, 2.499; 95% CI, 1.421-4.394; preoperative and intraoperative or postoperative: aOR, 2.436; 95% CI, 1.324-4.483) compared to patients without transfusions. Among elderly patients undergoing hip fracture surgery, PBT is observed to be associated with an increased risk of 30-day composite complications, and the timing of preoperative transfusion may represent a period of heightened risk.