An analysis of perioperative hidden blood loss in femoral intertrochanteric fractures: Bone density is an important influence factor

Abstract

[Background] To explore the influencing factors of perioperative hidden blood loss of intertrochanteric fractures. [Method] We undertook a retrospective analysis from January 2016 to October 2019. Clinical data of 118 patients with intertrochanteric fractures was included in. Hidden blood loss was calculated from the hematocrit changes before and after surgery, using the Gross equation, based on height, weight, and hematocrit (HCT) changes before and after surgery. Patients’ gender, age, presence of underlying diseases (hypertension and diabetes), fracture types, anesthesia methods, time from injury to surgery, whether to take antiplatelet drugs within 6 months before surgery, use of anticoagulant drugs after surgery, bone density were statistically analyzed. The factors with statistical significance were screened out. And then the hidden blood loss was used as the dependent variable and each influencing factor was the independent variable. Multivariate linear regression analysis was used to analyze the related risk factors that affect the hidden blood loss during the perioperative period of intertrochanteric fractures. [Result] The apparent blood loss during operation was (203.81 ±105. 51) ml, and the hidden blood loss was (517.55±191.47) ml. There were significant differences in the hidden blood loss of patients with different fracture types, anesthesia methods, antiplatelet or postoperative anticoagulant drugs, and different bone density(P＜0. 05). Multiple linear regression analysis showed that internal fixation, age, fracture type, anesthesia method, anticoagulant application, and bone density were related risk factors that affected hidden blood loss during surgical treatment of intertrochanteric fracture. [Conclusion] Hidden blood loss is the main cause of perioperative blood loss in intertrochanteric fractures, and the risk factors for hidden blood loss include internal fixation, fracture type, anesthesia, use of anticoagulant drugs. Specially, we found bone density was a risk factor for hidden blood loss. It is not reliable to use the apparent blood loss as the basis for fluid replacement and transfusion. We must fully consider the existence of hidden blood loss and intervene as soon as possible to prevent complications.