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Liberal intraoperative fluid management leads to increased complication rates in geriatric patients with hip fracture

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Abstract

Purpose

Fractures of the proximal femur in geriatric patients are life-changing and life-threatening events. Previous research has identified fluid volume as an independent factor contributing to trauma patients’ complications. Therefore, we aimed to investigate the impact of intraoperative fluid volume on outcomes in geriatric patients undergoing hip fracture surgery.

Methods

We conducted a retrospective single-center study with data from the hospital information systems. Our study included patients aged 70 years or older who had sustained a proximal femur fracture. We excluded patients with pathologic, periprosthetic, or peri-implant fractures and those with missing data. Based on the fluids given, we divided patients into high-volume and low-volume groups.

Results

Patients with a higher American Society of Anesthesiologists (ASA) grade and more comorbidities were more likely to receive more than 1500 ml of fluids. We observed significant differences in anesthesiologic management between the two groups, with a higher rate of invasive blood pressure management (IBP) and central venous catheter usage in the high-volume group. High-volume therapy was associated with a higher rate of complications (69.7% vs. 43.6%, p < 0.01), a higher transfusion rate (odds ratio 1.91 [1.26–2.91]), and an increased likelihood of patients being transferred to an intensive care unit (17.1% vs. 6.4%, p = 0.009). These findings were confirmed after adjusting for ASA grade, age, sex, type of fracture, Identification-of-Seniors-At-Risk (ISAR) score, and intraoperative blood loss.

Conclusions

Our study suggests that intraoperative fluid volume is a significant factor that impacts the outcome of hip fracture surgery in geriatric patients. High-volume therapy was associated with increased complications.

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Funding

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Author information

Authors and Affiliations

  1. Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany

    Bastian Pass, Fahd Malek, Bjoern Hussmann, Teresa Maek, Sven Lendemans & Carsten Schoeneberg

  2. Department of Orthopedics, Emergency Surgery and Hand Surgery, Florence-Nightingale-Hospital, Duesseldorf, Germany

    Denis Sieben

  3. Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany

    Rene Aigner & Christopher Bliemel

  4. Department of Orthopedics and Trauma Surgery, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany

    Bjoern Hussmann

  5. Department of Anesthesiology, Intensive Care and Pain Medicine, Alfried Krupp Hospital, Essen, Germany

    Daniel Dirkmann

  6. Department of Orthopedics and Trauma Surgery, Alfried Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany

    Bjoern Hussmann

Authors
  1. Bastian Pass
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  2. Denis Sieben
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  3. Fahd Malek
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  4. Bjoern Hussmann
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  5. Teresa Maek
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  6. Rene Aigner
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  7. Christopher Bliemel
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  8. Daniel Dirkmann
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  9. Sven Lendemans
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  10. Carsten Schoeneberg
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Contributions

BP: Prepared the manuscript, Analyzed the data, Designed the study. DS, FM, BH, TM, RA, CB, DD, SL: Analyzed the data, Reviewed the manuscript. CS: Designed the study, Analyzed the data, Prepared the manuscript. All authors declare that they have read and approved the final manuscript.

Corresponding author

Correspondence to Bjoern Hussmann.

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Conflict of interest

Bastian Pass, Denis Sieben, Fahd Malek, Bjoern Hussmann, Teresa Maek, Rene Aigner, Christopher Bliemel, Daniel Dirkmann, Sven Lendemans, and Carsten Schoeneberg declare that they have no conflict of interest.

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Pass, B., Sieben, D., Malek, F. et al. Liberal intraoperative fluid management leads to increased complication rates in geriatric patients with hip fracture. Eur J Trauma Emerg Surg 49, 2485–2493 (2023). https://doi.org/10.1007/s00068-023-02326-5

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  • DOI: https://doi.org/10.1007/s00068-023-02326-5

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