Assessing the impact of fracture pattern on transfusion requirements in hip fractures

Morris, Rhys; Rethnam, Ulfin; Russ, Bethan; Topliss, Claire

doi:10.1007/s00068-016-0655-8

Cited by 18 publications

(14 citation statements)

References 23 publications

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“…Intertrochanteric fractures (3.64 ± 1.60 days), trochatero-diaphysaire (4.60 ± 2.72 days) and basicervical fractures (4.71 ± 2.82 days) (p = 0.336) showed mean values without significant differences between sexes or age groups. In a comparative study of extra and intracapsular fractures, Morris et al (16), identified 39.4% vs. of 22.5% patients (p <0.001) requiring blood transfusions, more frequent among patients requiring intramedullary fixation vs. DHS (67.4 vs. 32.0%, p <0.001).…”

Section: Resultsmentioning

confidence: 99%

Preoperative Hemoglobin Dynamics in Patients with Trochanteric Fractures. A multivariate analysis

Gheorghevici¹,

Veliceasa²,

Puha³

et al. 2018

Rev. Chim.

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Preoperative anemia is a common finding among geriatric patients with trochanteric fractures. We assessed the dynamics of hemoglobin and the factors that influence it. A total of 780 patients with trochanteric fractures were selected. Distribution by gender showed a slightly higher proportion of female patients (64.1%). The preoperative interval ranged from a few hours to 19 days. Hospital admission period varied from 1 to 49 days. Hemoglobin ranged from 4.80 to 17.40 g/dl; 43.1% of patients had individual values below the baseline. Individually, the hemoglobin value varied from a decrease of 9.33 g/dL to an increase of 11.97 g/dL, but the total study group recorded an average decrease of 0.96 � 1.75 g/dL. Hemoglobin had a downward trend directly correlated with the preoperative interval period. Decrease in hemoglobin was correlated with the percentage of blood lymphocytes, PLT/WBC ratio, prothrombin activity and APTT ratio. A low level of hemoglobin variation was associated with a shorter preoperative interval, reduced prothrombin time, prothrombin activity ] 100, INR ] 1.50 and APTT ] 30.

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Section: Resultsmentioning

confidence: 99%

Preoperative Hemoglobin Dynamics in Patients with Trochanteric Fractures. A multivariate analysis

Gheorghevici¹,

Veliceasa²,

Puha³

et al. 2018

Rev. Chim.

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“…A shift from sliding hip to intramedullary nails are also seen in other Scandinavian countries [ 30 , 31 ] resulting in a lower reoperation for complex pertrochanteric fractures [ 32 ]. A higher use of intramedullary nails in the restrictive group may increase the likelihood of having a transfusion [ 24 , 25 , 28 , 33 ]. This would potentially lead to a slightly higher transfusion proportion in the restrictive group.…”

Section: Discussionmentioning

confidence: 99%

Introduction of national guidelines for restrictive blood transfusion threshold for hip fracture patients––a consecutive cohort study based on complete follow-up in national databases

et al. 2018

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BackgroundRandomized controlled trials have demonstrated that a restrictive red blood cell (RBC) transfusion strategy lowers transfusion frequency without affecting mortality. However, the external validity of these trials has not been tested in a large cohort. The purpose was to estimate the effect of introducing a National Clinical Guideline (NCG) for a restrictive hemoglobin transfusion threshold on transfusion frequency and mortality in hip fracture patients > 65 years old.MethodsA consecutive cohort study of hip fracture patients > 65 years old residing in the southern region of Denmark was conducted using prospectively gathered data from registers during two separate 1-year time periods. The first period from October 1, 2012, to September 30, 2013, included 1494 patients and used a liberal transfusion threshold, whereas the second period from October 1, 2015, to September 30, 2016, including 1414 participants used a restrictive threshold from the NCG. Participant data for age, sex, body mass index, Charlson Comorbidity Index, time to surgery, and death were retrieved from the Danish Interdisciplinary Registry of Hip Fractures and were merged with RBC transfusion and medication data extracted from the Danish Transfusion and Odense Pharmacoepidemiological Databases, respectively. Cox proportional hazards models were used to test relative mortality risk for the restrictive group compared with the liberal group at 30 and 90 days.ResultsOverall RBC transfusions decreased from 42 to 30% (p < 0.001). The 30-day mortality rate (95% CI) was 9% (8;11) in the restrictive group and 13% (11;14) in the liberal group (p < 0.008), whereas the adjusted relative mortality risk was 0.72 (0.57;0.91). The 90-day mortality rate was 15% (13;17) in the restrictive group and 19% (17;21) in the liberal group, whereas the adjusted relative mortality risk was 0.78 (0.65;0.94).ConclusionThese data suggest that the introduction of an NCG on restrictive blood transfusion leads to lower transfusion frequency in hip fracture patients > 65 years old. Even though this reduction is associated with decreased mortality at both 30 and 90 days, it may be explained by other issues than restrictive transfusion strategy. There has been an improvement in the mortality of hip fracture patients in Denmark, and we suggest that a restrictive transfusion strategy does not lead to increased mortality.

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“…Other factors: According to the literature (Morris et al, 2017), hidden blood loss in intertrochanteric fracture is associated with other factors such as gender, weight, underlying disease, drug factors; mechanism of injury, damage energy, and fracture type etc. These factors are statistically significant and still controversial currently thus further studies are necessary.…”

Section: Discussionmentioning

confidence: 99%

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2018

IRJPEH

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To compare perioperative hidden blood loss in the treatment of femoral intertrochanteric fractures with percutaneous compression plate (PCCP) and proximal femoral nail anti-rotation (PFNA) in elderly patients, and analyse its influencing factors in order to provide the necessary data support for clinical perioperative treatment, and choice of appropriate internal fixation method. Retrospective analyses was carried out on data obtained from 158 patients with intertrochanteric fracture treated with PCCP or PFNA from January 2010 to May 2017. Data were obtained from variables such as age, gender, height, weight, operative bleeding and postoperative drainage, operation time, etc. Upon blood routine examination before and after surgery (RBC, Hb and Hct), total and hidden blood losses were calculated using Gross equations. A comparative analysis was carried out on the differences in hidden blood loss, postoperative complications and prognosis between PCCP and PFNA.Visible blood loss was higher in PCCP than in PFNA, but total and hidden blood losses were significantly lower in PFNA(P<0.05). Within the two groups, hidden blood loss in elderly patients was significantly higher (P<0.05). Start time of weight-bearing of PCCP group was significantly longer than of PFNA group (P<0.05), but incidences of complications of important organs and perioperative mortality in PCCP group were significantly lower than those of PFNA group (P<0.05). There were no significant differences in operation time, infection of incision, failure of internal fixation, fracture healing time, or Harris function score of half year after operation between the two groups (P<0.05). There is serious hidden blood loss before and after operation in elderly patients with femoral intertrochanteric fractures, of which intramedullary fixation is higher. Intramedullary fixation causes more severe complications of important organs than extramedullary fixation.

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Assessing the impact of fracture pattern on transfusion requirements in hip fractures

Abstract: Patients with IT hip fractures are significantly more likely to require an ABT than those with IC hip fractures. Patients undergoing an intramedullary nail for IT fractures have significantly higher transfusion rates than for other types of operation.

Cited by 18 publications

References 23 publications

Preoperative Hemoglobin Dynamics in Patients with Trochanteric Fractures. A multivariate analysis

Preoperative Hemoglobin Dynamics in Patients with Trochanteric Fractures. A multivariate analysis

Introduction of national guidelines for restrictive blood transfusion threshold for hip fracture patients––a consecutive cohort study based on complete follow-up in national databases

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