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Risk factors analysis and nomogram construction for blood transfusion in elderly patients with femoral neck fractures undergoing hemiarthroplasty

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A Letter to the Editor to this article was published on 01 August 2022

Abstract

Introduction

Elderly patients with femoral neck fractures (FNFs) undergoing hemiarthroplasty usually have poor physical condition. The main aim of this study was to identify risk factors for blood transfusion in these patients and construct a nomogram to intuitively predict the requirement of transfusion. The secondary purpose was to examine the relationship between blood transfusion and complications within 30 days post-operatively. Our hypothesis was that chronic kidney disease (CKD) and hypoalbuminemia may increase the requirement of transfusion.

Methods

Data of 414 elderly patients undergoing hemiarthroplasty for FNFs were retrospectively collected. Univariate and multiple regression analysis were performed to identify independent risk factors for blood transfusion, which were used to construct a nomogram subsequently. The discrimination and calibration of the nomogram model were assessed with concordance index (C-index), the area under receiver operating characteristic curve (AUC), and calibration curve. Furthermore, the complications of blood transfusion within 30 days post-operatively were also analyzed.

Results

Out of 414 patients, 127 (30.7%) received a blood transfusion. Independent risk factors for blood transfusion included CKD, hypoalbuminemia, pre-operative anaemia, general anaesthesia, higher American Society of Anesthesiologists score, more intraoperative blood loss, and longer surgical time. Increased hidden blood loss, deep vein thrombosis, superficial wound infection, and prolonged hospital stays were more common in transfused patients. The C-index of the nomogram model was 0.848 (95% CI = 0.811–0.885), and the AUC value was 0.859. The calibration curve showed a good consistency between the actual transfusion and the predicted probability.

Discussion

We observed a transfusion rate of 30.7% in elderly FNF patients undergoing hemiarthroplasty. CKD and hypoalbuminemia were firstly identified as independent risk for blood transfusion. In addition, blood transfusion can increase the occurrence of early post-operative complications.

Conclusion

Targeted pre-operative intervention, such as optimizing CKD and correcting hypoalbuminemia is essential and highly regarded.

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Data availability

The data contributing to this article may be made available upon request by sending an e-mail to the first author.

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Acknowledgements

We appreciate the contribution of all patients, the investigators, and the medical staff.

Funding

This study was supported by the Non-profit Central Research Institute Fund of the Chinese Academy of Medical Sciences [2019PT320001].

Author information

Authors and Affiliations

  1. Shanxi Bethune Hospital, Shanxi Academy of Medical Science, No. 99, Longcheng Street, Taiyuan, 030032, Shanxi Province, China

    Jian Zhu

  2. School of Medicine, Nankai University, Tianjin, 300071, People’s Republic of China

    Jian Zhu, Xiangtian Deng & Yingze Zhang

  3. Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People’s Republic of China

    Jian Zhu, Xiangtian Deng, Xiaodong Cheng, Yonglong Li, Wei Chen & Yingze Zhang

  4. Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Jian Zhu, Xiangtian Deng, Xiaodong Cheng, Yonglong Li, Wei Chen & Yingze Zhang

  5. NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Jian Zhu, Xiangtian Deng, Xiaodong Cheng, Yonglong Li, Wei Chen & Yingze Zhang

  6. Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China

    Hongzhi Hu

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  1. Jian Zhu
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Contributions

Yingze Zhang and Wei Chen contributed to the study conception and design. Material preparation and data collection were performed by Xiangtian Deng, Xiaodong Cheng, and Hongzhi Hu. Yonglong Li analyzed and interpreted the data. The first draft of the manuscript was written by Jian Zhu and Xiangtian Deng. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yingze Zhang.

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This retrospective study was approved by the Third Hospital of Hebei Medical University, and all participants provided written informed consents.

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Zhu, J., Hu, H., Deng, X. et al. Risk factors analysis and nomogram construction for blood transfusion in elderly patients with femoral neck fractures undergoing hemiarthroplasty. International Orthopaedics (SICOT) 46, 1637–1645 (2022). https://doi.org/10.1007/s00264-022-05347-8

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