Perioperative blood loss and transfusion requirements in patients with fractured neck of femur

Marval, Paul; Hardman, Jonathan G.

doi:10.1017/s0265021504215113

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…Although the differences are statistically significant, the numeric differences are small and their clinical relevance is uncertain. Other studies have shown up to 20 percent increase in blood loss in acetylsalicylic acid treated patients, but no significant increase in mortality [10,20]. Although some studies have shown doubled amount of bleeding complications in LdAA treated patients, the clinical significance of these complications has been disputed.…”

Section: Discussionmentioning

confidence: 99%

“…The 100 g/L hemoglobin level used as threshold for transfusion in our study may be considered to be relatively high. However, some previous studies have used a similar threshold although others have used a threshold as low as 85 g/L [20]. The indication for red cell transfusions should ideally be identified individually for each patient instead of a set pretransfusion threshold and be based on premorbidity and relevant clinical risk.…”

Section: Discussionmentioning

confidence: 99%

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Bleeding and first-year mortality following hip fracture surgery and preoperative use of low-dose acetylsalicylic acid: an observational cohort study

Kragh

Waldén

Apelqvist

et al. 2011

BMC Musculoskelet Disord

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BackgroundHip fracture is associated with high mortality. Cardiovascular disease and other comorbidities requiring long-term anticoagulant medication are common in these mostly elderly patients. The objective of our observational cohort study of patients undergoing surgery for hip fracture was to study the association between preoperative use of low-dose acetylsalicylic acid (LdAA) and intraoperative blood loss, blood transfusion and first-year all-cause mortality.MethodsAn observational cohort study was conducted on patients with hip fracture (cervical requiring hemiarthroplasty or pertrochanteric or subtrochanteric requiring internal fixation) participating in a randomized trial that found lack of efficacy of a compression bandage in reducing postoperative bleeding. The participants were 255 patients (≥50 years) of whom 118 (46%) were using LdAA (defined as ≤320 mg daily) preoperatively. Bleeding variables in patients with and without LdAA treatment at time of fracture were measured and blood transfusions given were compared using logistic regression. The association between first-year mortality and preoperative use of LdAA was analyzed with Cox regression adjusting for age, sex, type of fracture, baseline renal dysfunction and baseline cardiovascular and/or cerebrovascular disease.ResultsBlood transfusions were given postoperatively to 74 (62.7%) LdAA-treated and 76 (54%) non-treated patients; the adjusted odds ratio was 1.8 (95% CI 1.04 to 3.3). First-year mortality was significantly higher in LdAA-treated patients; the adjusted hazard ratio (HR) was 2.35 (95% CI 1.23 to 4.49). The mortality was also higher with baseline cardiovascular and/or cerebrovascular disease, adjusted HR 2.78 (95% CI 1.31 to 5.88). Patients treated with LdAA preoperatively were significantly more likely to suffer thromboembolic events (5.7% vs. 0.7%, P = 0.03).ConclusionsIn patients with hip fracture (cervical treated with hemiarthroplasty or pertrochanteric or subtrochanteric treated with internal fixation) preoperative use of low-dose acetylsalicylic acid was associated with significantly increased need for postoperative blood transfusions and significantly higher all-cause mortality during one year after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bleeding and first-year mortality following hip fracture surgery and preoperative use of low-dose acetylsalicylic acid: an observational cohort study

Kragh

Waldén

Apelqvist

et al. 2011

BMC Musculoskelet Disord

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“…This transfusion threshold has been used in some studies (Anekstein et al 2004, Muir 1995) but other studies have used lower thresholds of 70–90 g/L (Marval and Hardman 2004). One pilot study randomized 84 patients with hip fracture to receive transfusion if Hb levels dropped below the predefined threshold of 100 g/L, or to receive transfusion only for symptoms of anemia or a Hb of less than 80 g/L, but no firm conclusions could be drawn from that study (Carson et al 1998b).…”

Section: Discussionmentioning

confidence: 99%

Pneumatic wound compression after hip fracture surgery did not reduce postoperative blood transfusion

et al. 2009

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Background and purpose Patients with fracture of the proximal femur often undergo blood transfusion. A pneumatic compression bandage has been shown to reduce transfusion after primary hip arthroplasty for osteoarthritis. In this randomized trial, we evaluated the efficacy of this bandage following surgery for hip fracture.Patients and methods 288 patients, 50 years or older with 292 fractured hips treated with hemiarthroplasty or internal fixation (except pinning), were randomized to an experimental group with pneumatic wound compression applied after surgery (n = 138) and a control group with the same dressing but no compression (n = 154). Transfusion threshold was blood hemoglobin below 100 g/L. The primary outcome measures were the number of blood units and the proportion of patients transfused after surgery.Results The primary outcome measures were similar in both groups. The mean number of postoperatively transfused blood units was 1.3 in the compression group and 1.1 in the non-compression group. Blood transfusion was given to 84 patients (62%) in the compression group and to 85 patients (55%) in the non-compression group.Interpretation Pneumatic wound compression does not reduce the need for transfusion after hip fracture surgery.

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Anaemia impedes functional mobility after hip fracture surgery

2008

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Perioperative blood loss and transfusion requirements in patients with fractured neck of femur

Cited by 4 publications

References 4 publications

Bleeding and first-year mortality following hip fracture surgery and preoperative use of low-dose acetylsalicylic acid: an observational cohort study

Bleeding and first-year mortality following hip fracture surgery and preoperative use of low-dose acetylsalicylic acid: an observational cohort study

Pneumatic wound compression after hip fracture surgery did not reduce postoperative blood transfusion

Anaemia impedes functional mobility after hip fracture surgery

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