An ePoster reported the results of a five-year study investigating the effects of pre-injury anemia on morbidity and mortality risk for geriatric patients with hip fractures. The following is an interview with Abhishek Ganta, MD, assistant professor in the Department of Orthopedic Surgery at NYU Grossman School of Medicine.
Published 12/17/2025
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Heather Knox
An ePoster presented at the AAOS 2025 Annual Meeting reported the results of a five-year study investigating the effects of pre-injury anemia on morbidity and mortality risk for geriatric patients with hip fractures. The poster was presented by Abhishek Ganta, MD, assistant professor in the Department of Orthopedic Surgery at NYU Grossman School of Medicine. The study determined that older adults with pre-existing anemia face significantly worse outcomes six months to one year after hip fracture surgery, including higher rates of complications, readmissions, transfusions, and mortality. Dr. Ganta sat down with AAOS Now to discuss these findings and their implications for practice.
Background and motivation
Previous research has found that many older adults who sustain hip fractures present with anemia, and evidence links lower hemoglobin levels with worse postoperative outcomes. In a retrospective analysis of 3,540 patients with hip fractures, just more than 55% had preoperative anemia, which was associated with nearly double the incidence of major in-hospital complications compared to non-anemic patients. Another retrospective study of elderly patients undergoing hip fracture surgery demonstrated that preoperative anemia was independently associated with increased mortality at 90 and 180 days. In addition to mortality and complication risks, anemia has been associated with longer hospital length of stay and delayed functional recovery, including nonunion and failure of fracture fixation, in hip fracture patients.
With the prevalence of hip fractures on the rise, identifying anemia as a modifiable risk factor in preoperative assessment is key, alongside long-term fracture-prevention strategies. Early recognition and targeted management of anemia may provide opportunities to optimize perioperative care, improve rehabilitation, and reduce the risk of subsequent fractures and associated complications.
Dr. Ganta’s experience with patients coming in with anemia raised questions for his team. “Are people presenting anemic? Are people getting anemic from the injury? Are these people who are anemic to begin with? A lot of those patients had complications after surgery. [We wanted to] see if there’s anything we can do to identify these patients and prevent these [hip fractures] from happening or try to create a pathway to prevent complications from occurring in these patients.”
Anemia and hip fracture outcomes
Through a retrospective review of 3,789 geriatric hip fracture cases at a single institution over five years, Dr. Ganta and colleagues identified 498 patients (13.1%) with hemoglobin values recorded between six and 12 months before surgery. Of those, 273 (54.8%) met World Health Organization criteria for anemia, with hemoglobin values less than 12 grams per deciliter for women and 13.5 for men; 225 did not. The two groups differed significantly in sex distribution, Charlson Comorbidity Index, pre-injury ambulatory status, and Score for Trauma Triage in the Geriatric and Middle Aged (STTGMA), reflecting differences in baseline risk profiles. Compared with the non-anemic cohort, patients with pre-injury anemia had significantly worse STTGMA risk profiles.
After adjusting for STTGMA, analysis revealed that pre-injury anemia was independently associated with worse outcomes following hip fracture. Anemic patients demonstrated significantly higher rates of readmission at 30 and 90 days, increased one-year mortality, and a greater incidence of major complications — including sepsis, pneumonia, myocardial infarction, pulmonary embolus, stroke, and respiratory failure. These findings indicate that anemia present prior to injury is not only a marker of frailty but also a predictor of poorer recovery and increased healthcare utilization.
Clinical interventions
Dr. Ganta emphasized the need for outreach to primary care physicians to help identify patients who are at risk for future hip fracture, specifically noting that anemia appears to be an additional risk factor. He also suggested interventions such as balance training and fall-prevention programs to minimize the risk of future hip fractures in patients with pre-injury anemia, explaining that these measures are cost-effective and have significant community outreach potential.
Another intervention he discussed was the potential impact of nutrition supplementation in patients with hip fractures — something the NYU trauma group has started trying to implement despite challenges. He explained that many patients come in with some degree of muscle wasting and have difficulty eating after surgery. Family involvement is crucial for helping these patients take their supplements routinely.
“If there’s something that we can do as a modified and easily applicable intervention to help patients through their recovery process, I think it definitely goes a long way in terms of minimizing some of the complications that patients with hip fractures can have,” Dr. Ganta shared.
Heather Knox is the associate editor of AAOS Now. She can be reached at hknox@aaos.org.
References
- Ganta A, Linker JA, Pettit CJ, et al. The slow bleed: Pre-injury anemia is associated with increased risk for mortality in geriatric hip fracture patients. Paper presented at: AAOS 2025 Annual Meeting; March 10-14, 2025; San Diego, California.
- Ryan G, Nowak L, Melo L, et al. Anemia at presentation predicts acute mortality and need for readmission following geriatric hip fracture. JB JS Open Access. 2020;5(3):e20.00048. doi:10.2106/JBJS.OA.20.00048
- Jiang Y, Lin X, Wang Y, et al. Preoperative anemia and risk of in-hospital postoperative complications in patients with hip fracture. Clin Interv Aging. 2023;18:639-653. doi:10.2147/CIA.S404211
- Haddad BI, Hamdan M, Alshrouf MA, et al. Preoperative hemoglobin levels and mortality outcomes after hip fracture patients. BMC Surg. 2023;23(1):266. doi:10.1186/s12893-023-02174-5
- Zhang N, Zhang D, Ren S, et al. Relationship between preoperative hemoglobin levels and length of stay in elderly patients with hip fractures: A retrospective cohort study. Medicine (Baltimore). 2024;103(25):e38518. doi:10.1097/MD.0000000000038518