Plasma Fibrinogen as a Predictor of Perioperative-Blood-Component Transfusion in Major-Nontraumatic-Orthopedic-Surgery Patients: A Cohort Study

Abstract

There is a trend towards increased perioperative bleeding in patients with plasma fibrinogen levels < 200 mg/dL−1. This study aimed to assess whether there is an association between preoperative fibrinogen levels and perioperative blood-product transfusion up to 48 h after major orthopedic surgery. This cohort study included 195 patients who underwent primary or revision hip arthroplasty for nontraumatic etiologies. Plasma fibrinogen, blood count, coagulation tests, and platelet count were measured preoperatively. A plasma fibrinogen level of 200 mg/dL−1 was the cutoff value used to predict blood transfusion. The mean (SD) plasma fibrinogen level was 325 (83) mg/dL−1. Only thirteen patients had levels < 200 mg/dL−1, and only one of them received a blood transfusion, with an absolute risk of 7.69% (1/13; 95%CI: 1.37–33.31%). Preoperative plasma fibrinogen levels were not associated with the need for blood transfusion (p = 0.745). The sensitivity and the positive predictive value of plasma fibrinogen < 200 mg/dL−1 as a predictor of blood transfusion were 4.17% (95%CI: 0.11–21.12%) and 7.69% (95%CI: 1.12–37.99%), respectively. Test accuracy was 82.05% (95%CI: 75.93–87.17%), but positive and negative likelihood ratios were poor. Therefore, preoperative plasma fibrinogen level in hip-arthroplasty patients was not associated with the need for blood-product transfusion.

Development and Validation of a Machine Learning Algorithm to Predict the Risk of Blood Transfusion after Total Hip Replacement in Patients with Femoral Neck Fractures: A Multicenter Retrospective Cohort Study

“…Several studies have reported various blood transfusion‐related risk factors such as artificial heart valve presence, 11 anesthesia choice, 12 and maximum clot firmness (FIBTEM), 61 which were not included in our prediction model. Although fibrinogen, 10 free fatty acids 13 and other factors were considered, the small sample size prevented us from establishing a correlation with blood transfusion. We anticipate that with a larger database, future studies will identify and incorporate more factors affecting postoperative blood transfusion, such as the patient's primary disease, anesthesia type, surgical approach, degree of injury, and blood coagulation hardness, thereby enhancing the model's predictive accuracy.…”

“…Numerous studies have analyzed the risk factors associated with blood transfusion after total hip surgery, 9 , 10 , 11 , 12 , 13 , 14 including patient baseline information, surgical details, and preoperative test indicators. However, few studies have integrated these data to assess their relative importance in determining postoperative blood transfusion risk.…”