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

Abstract

Background To explore the influencing factors of perioperative hidden blood loss in intertrochanteric fractures. Method We undertook a retrospective analysis from January 2016 to October 2019. Clinical data of 118 patients with intertrochanteric fractures were included. Hidden blood loss was calculated from the haematocrit changes before and after surgery using the Gross equation based on height, weight, and haematocrit (HCT) changes before and after surgery. Patients’ gender, age, presence of underlying diseases, fracture types, anaesthesia methods, time from injury to surgery, administration of antiplatelet drugs within 6 months before surgery, use of anticoagulant drugs after surgery, and bone density were statistically analysed. Factors having an effect on hidden blood loss were screened out. Then, hidden blood loss was used as the dependent variable, and each influencing factor was used in turn as the independent variable. Multivariate linear regression analysis was employed to analyse the related risk factors that affect hidden blood loss during the perioperative period of patients with intertrochanteric fractures. Result The apparent blood loss during the 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 (stable vs unstable), anaesthesia methods (general anaesthesia vs intraspinal anaesthesia), antiplatelet or postoperative anticoagulant drugs, and bone densities (P< 0.05). 05). Multiple linear regression analysis showed that internal fixation, age, fracture type, anaesthesia method, anticoagulant application, and bone density were related risk factors that affected hidden blood loss during the surgical treatment of intertrochanteric fractures. 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 (e.g., unstable), anaesthesia (e.g., intraspinal), and use of anticoagulant drugs. Specifically, we found that low bone density was a risk factor for hidden blood loss. It is not reliable to use 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. Level of evidence III

Risk Factors for Perioperative Hidden Blood Loss After Intertrochanteric Fracture Surgery in Chinese Patients: A Meta-Analysis

“…Kumar 26 and Luo 14 observed a significant correlation between the amount of HBL and the fracture types. Furthermore, Cui 13 found that patients with AO/OTA types 31-A2.2 to 31-A3.3 fractures had more HBL than those with AO/OTA types 31-A2.2 to 31-A3.3 fractures, which was the same as our results. It was obvious that unstable fractures were more serious than stable fractures, which could definitely cause more HB.…”

“… 10 , 11 , 15 However, slight differences were present for body mass index (BMI). Liu 10 proved that BMI<25 kg/m 2 was a risk factor in the univariate analyses, but not in the multivariate analyses, whereas Cui 13 demonstrated that BMI was not a predictive factor, no matter in the univariate analyses or multivariate analyses. Our results showed no relationship between BMI (<28 kg/m 2 vs BMI ≥28 kg/m 2 ) and perioperative HBL.…”

Risk Factors Analysis and the Establishment of Nomogram Prediction Model of Hidden Blood Loss After Total Hip Arthroplasty for Femoral Neck Fracture in Elderly Women

“…It has been previously reported that low bone density is a significant risk factor for HBL after hip fracture. 26 Considering that the bone density of osteoporosis in elderly women was reduced, and the bone trabecula was narrowed or even broken, thus increasing the bone marrow space. Therefore, after proximal femur osteotomy, blood flowed into the enlarged bone marrow space, resulting in an increase of HBL.…”

Effect of Wearing Medical Masks on Perioperative Respiratory Complications in Older Adults with Hip Fracture: A Retrospective Cohort Study

“…The possible cause of the difference is that intertrochanteric fractures tend to receive greater violence and be more serious than femoral neck fractures, which are manifested in abundant local blood supply, obvious swelling, ecchymosis, and severe pain. 43–45 …”