In hip fracture patients, who are mostly elderly, preexisting anemia can be worsened when combined with trauma and surgery. To this date, there is no unequivocal approach about transfusion thresholds. We analyzed hemoglobin (Hb) and hematocrit (Hct) levels at three time points in surgical patients with proximal femoral fractures (PFF) to see which levels were triggers for transfusions and whether transfusions were related to mortality after hospital discharge. A total of 956 patients were operated on from 1 January 2021 to 31 December 2022 at the University Hospital of Split and included in the study. There were more women (74%); 47% patients had admission Hb < 120 g/L. Transfusion was given preoperatively to 88, intraoperatively to 74 and postoperatively to 309 patients. Transfusion thresholds were as follows: Hb 84 g/L preoperatively, 99 intraoperatively and 83 postoperatively. After hospital discharge, 10.79% of patients died within the 1st month and 23% within 6 months. In the group of non-survivors, 60% of patients had admission Hb ≤ 117 g/L and the proportion of patients transfused preoperatively was two times higher. Preoperative transfusion thresholds could be set to higher levels for patients with surgically treated PFF. However, that could increase mortality even more. Further investigation is necessary.

Background/Objectives: Hip fractures are associated with high short-term mortality in older adults. This study aimed to determine 30-day mortality after hip fracture surgery and evaluate factors associated with short-term mortality, with particular attention to baseline comorbidity indices and in-hospital adverse events. Methods: This retrospective cohort study included 785 patients who underwent surgery for hip fracture at University Hospital of Split, Croatia, between January 2021 and December 2022. Clinical data were extracted from medical records. The primary outcome was 30-day mortality, including in-hospital and post-discharge deaths. Associations with mortality were examined using univariable and multivariable logistic regression. Baseline-only comorbidity models were constructed using the American Society of Anesthesiologists Physical Status Classification System (ASA PS Classification), the Charlson Comorbidity Index (CCI), and the Elixhauser Comorbidity Index (ECI). Exploratory hospital-course models additionally included in-hospital adverse events, which were interpreted as time-dependent hospital-course events rather than baseline predictors. Results: 30-day mortality was 11.0% (86/785). Older age, male sex, higher comorbidity burden, and in-hospital adverse events were associated with mortality. Mortality was 5.7% without documented adverse events, 24.2% with one adverse event, and 42.4% with two or more adverse events. Baseline-only comorbidity models showed acceptable and broadly comparable discrimination, with AUCs of 0.73–0.77. Exploratory hospital-course models showed higher discrimination, with AUCs of 0.80–0.82. Conclusions: 30-day mortality after hip fracture surgery was associated with baseline patient vulnerability and in-hospital adverse events. Baseline-only models based on the ASA PS Classification, the CCI, and the ECI provided broadly comparable short-term risk stratification. In-hospital adverse events should be viewed as markers of an adverse clinical trajectory, not evidence of causality.