Preoperative moderate renal impairment is an independent risk factor of transfusion in elderly patients undergoing hip fracture surgery and receiving low-molecular-weight heparin for thromboprophylaxis

Lejus, Corinne; Desdoits, Aurore; Lambert, Chantal; Langlois, Cécile; Roquilly, Antoine; Asehnoune, Karim

doi:10.1016/j.jclinane.2011.10.015

Cited by 10 publications

(6 citation statements)

References 24 publications

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“…Carson et al have previously shown that surgical patients with cardiovascular disease have a greater incidence of morbidity and mortality if they had a hemoglobin level of 100 g/L or less. 35 With regards to chronic disease in the elderly population, patients with chronic renal impairment have been shown to have an increased incidence of transfusion in the perioperative period 36 and so this group should also be given special consideration. With regards to this study, patients taking some form of anticoagulation were excluded due to the fact that this subpopulation will intrinsically have significant comorbidities and should therefore be monitored on an individual basis.…”

Section: Discussionmentioning

confidence: 99%

An analysis of postoperative hemoglobin levels in patients with a fractured neck of femur

Nagra¹,

Popta²,

Whiteside³

et al. 2016

Acta Orthopaedica et Traumatologica Turcica

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ObjectivesThe aim of this study was to analyze the changes in hemoglobin level and to determine a suitable timeline for post-operative hemoglobin monitoring in patients undergoing fixation of femoral neck fracture.Patients and methodsPatients who underwent either dynamic hip screw (DHS) fixation (n = 74, mean age: 80 years) or hip hemiarthroplasty (n = 104, mean age: 84 years) for femoral neck fracture were included into the study. The hemoglobin level of the patients was monitored perioperatively.ResultsAnalysis found a statistically and clinically significant mean drop in hemoglobin of 31.1 g/L over time from pre-operatively (D0) to day-5 post-operatively (p < 0.001), with significant reductions from D0 to day-1 and day-1 to day-2 (p < 0.001). At each post-operative time point, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p = 0.046).ConclusionThe decrease in hemoglobin in the first 24-h post-operative period (D0 to day-1) is an underestimation of the ultimate lowest value in hemoglobin found at day-2. Relying on the day-1 hemoglobin could be detrimental to patient care. We propose a method of predicting patients likely to be transfused, and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.Level of evidenceLevel IV Prognostic study.

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Section: Discussionmentioning

confidence: 99%

An analysis of postoperative hemoglobin levels in patients with a fractured neck of femur

Nagra¹,

Popta²,

Whiteside³

et al. 2016

Acta Orthopaedica et Traumatologica Turcica

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“…Indeed, our CRD sample had a higher prevalence of multiple comorbidities—including diabetes, hypertension, peripheral vascular disease, cardiac disease, and alcohol abuse. CRD has been cited as a risk factor for increased mortality, infection, and other morbidity (Bozic et al 2012a, b, Shorr et al 2012, Rodriguez-Merchen 2012) and individuals with CRD reportedly have a higher complication rate when undergoing a variety of orthopedic procedures (Lejus et al 2012, Pumberger et al 2012). Patients with TKA may be further affected, as CRD has been noted to have a deleterious effect on the anatomic structures in and around the knee (Muratli et al 2005).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with CRD are more likely to have associated medical problems (Go et al 2004), the disease is a risk factor for postoperative complications (Shorr et al 2012), and the impact of renal impairment on patients undergoing orthopedic procedures has been documented (Lejus et al 2012, Pumberger et al 2012). Furthermore, arthroplasty patients have previously been shown to have reduced renal function as they recover from this surgery (Nergelius et al 1997).…”

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confidence: 99%

Can total knee arthroplasty be safely performed in patients with chronic renal disease?

Miric¹,

Inacio²,

Namba³

2014

Acta Orthopaedica

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Background and purposeThe prevalence of chronic renal disease (CRD) is rising worldwide. Patients with CRD are more likely to have associated medical problems and are at greater risk of postoperative morbidity and mortality. We evaluated patient characteristics and risk of early revision, surgical site infection (SSI), thromboembolic events, mortality, and re-admission of patients with CRD undergoing total knee arthroplasty (TKA). We hypothesized that this patient population would have higher rates of complications.Patients and methodsWe conducted a retrospective analysis of data that had been prospectively collected by a Total Joint Replacement Registry. All primary TKAs performed from 2005 through 2010 were included. 41,852 primary TKA cases were evaluated, of which 2,686 (6.4%) TKA procedures had been performed in CRD patients. Patient characteristics, comorbidities, and general health status were evaluated. Cox proportional hazard regressions and logistic regressions were used to evaluate the association of CRD with outcomes while adjusting for confounding variables.ResultsThe mean age of the CRD cohort was 67 years and approximately two-thirds of the patients were female. The median follow-up time was 2.1 years. Compared to TKA patients without CRD the CRD patients were older, had poorer general health, and had a higher prevalence of comorbidities. They had a higher incidence of deep SSI (0.9% vs. 0.7%), superficial SSI (0.5% vs. 0.3%), deep vein thrombosis (0.6% vs. 0.4%), any-time mortality (4.7% vs. 2.4%), 90-day mortality (0.4% vs. 0.2%), and 90-day re-admission (10% vs. 6.0%) than patients without CRD. However, after adjustment for confounding variables, CRD patients were at 1.9 times (95% CI: 1.1–3.5) increased risk of superficial SSI, 1.3 times (CI: 1.1–1.6) increased risk of re-admission within 90 days, and 1.5 times (CI: 1.2–1.8) increased risk of mortality at any point after the procedure. The risks of all other complications were not statistically significantly different in patients with CRD compared to patients without CRD.ConclusionsCRD patients undergoing TKA have more comorbidities and a higher risk for superficial SSI, 90-day re-admission, and any-time mortality.

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“…5 However, renal impairment in elderly patients undergoing hip fracture surgery occurs frequently but does not benefit from early diagnosis where only the currently recognized markers are used. 2 Indeed, perioperative detection of AKI is difficult as serum creatinine (sCr) concentration or clearance and urine output lack specificity and sensitivity. 7 …”

Section: Introductionmentioning

confidence: 99%

The Doppler renal resistive index for early detection of acute kidney injury after hip fracture

Marty

Ferré

Labaste

et al. 2016

Anaesthesia Critical Care & Pain Medicine

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Preoperative moderate renal impairment is an independent risk factor of transfusion in elderly patients undergoing hip fracture surgery and receiving low-molecular-weight heparin for thromboprophylaxis

Cited by 10 publications

References 24 publications

An analysis of postoperative hemoglobin levels in patients with a fractured neck of femur

An analysis of postoperative hemoglobin levels in patients with a fractured neck of femur

Can total knee arthroplasty be safely performed in patients with chronic renal disease?

The Doppler renal resistive index for early detection of acute kidney injury after hip fracture

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