Associations between Red Blood Cell Transfusions and Health-Related Outcomes in Older Adults with Hip Fractures: A Systematic Review with Meta-Analysis

Background: Hip fractures (HFs) are increasingly common in aging populations and often require surgical intervention, leading to significant blood loss from both the injury and the procedure, increasing the need for red blood cell (RBC) transfusions. Despite evidence from randomized controlled trials, indicating the risks associated with RBC transfusions, they remain a standard treatment for patients with HF. This systematic review and meta-analysis aimed to evaluate the impact of RBC transfusions on mortality and 30 d clinical outcomes. Methods: We conducted a systematic review of observational and experimental studies on RBC transfusions in adults undergoing HP surgery. Without language restrictions, we searched PubMed, Scopus, Web of Science, and EMBASE up to September 1, 2024. Effect sizes for continuous variables are reported as means with 95% confidence intervals (CIs), whereas dichotomous variables are reported as risk ratios with 95% CIs. A random-effects model was used for the analysis. Results: We included 26 studies involving 59,627 patients with HF, 42% of whom received RBC transfusions. Transfusion rates varied widely by country. Women and older patients with HF received fewer RCB transfusions than men and those under 90 years old. RBC transfusions were associated with increased 30 d mortality, 30 d skin infections, and pneumonia, with a tendency toward higher 1 year mortality. Conclusions: RBC transfusions in patients with HF are associated with increased risks of 30 d mortality, 30 d skin infections, and pneumonia. Careful consideration is essential when administering transfusions to this vulnerable population.