Advertisement

Transfusion requirements in hip fractures: analysis of predictive factors

  • Arif GulEmail author
  • S. Sambandam
  • V. Shanbhag
  • G. Morgan
Original Article
  • 89 Downloads

Abstract

Background

The primary objective of this study was to identify factors which determine blood transfusion requirements in patients with hip fractures. Predicting a target population at a higher risk of requiring blood transfusion would enable a selective cross-matching policy and also help to establish the appropriate prophylactic measures.

Methods

It was a retrospective study including the time period between February 2003 and February 2005. All patients admitted with fracture neck of femur were included in the study. The following variables were noted perioperative Hb levels, type of fracture and surgery, age and gender and blood transfusion in the perioperative period.

Results

There were 238 female and 72 male patients. The mean age was 82.7 years; range 53–100. Out of a total of 310 patients, 49 patients required a postoperative blood transfusion. The mean preoperative Hb of patients who required transfusion was 11; S.D.1.49 while those who did not require a transfusion it was 12.5; S.D.1.42. There were 168 hemiarthroplasties and 142 DHS fixations. Patients undergoing a DHS had a mean preoperative Hb level of 12.1 and a mean postoperative Hb of 9.1. Transfusion was required in 33 (23%) patients. Patients having hemiarthroplasty had a mean preoperative Hb level of 12.4 and a mean postoperative Hb of 10. Transfusion was requried in 16 (9.5%) patients. The univariate analysis showed a significant relationship between postoperative transfusion and the preoperative Hb level (P = 0.0001) and the type of fracture (= 0.001). However no relationship was found between transfusion and the age (= 0.423) and the gender of the patient (= 0.611). Preoperative Hb and type of fracture were found to be statistically significant on multivariate analysis as well.

Conclusions

The results of our study indicate that the most important factor in the prediction for blood transfusion in fracture neck of femur is the preoperative level of haemoglobin although the type of fracture is also important. Restrictive cross-matching for the high risk cases would improve costs in healthcare delivery and prevent unnecessary use of blood resources

Keywords

Transfusion Hip fractures Predictive factors 

Besoins transfusionnels dans les fractures de hanche

Résumé

Buts

L’objectif fondamental de cette étude était d’identifier les facteurs qui déterminent les exigences de la transfusion de sang chez les patients ayant une fracture de la hanche. Prédire une population cible à plus haut risque d’exiger la transfusion du sang permettrait une politique de tri sélective et aussi aiderait à établir les mesures prophylactiques appropriées.

Méthodes

Il s’est agi d’une étude rétrospective entre février 2003 et février 2005. Tous les malades admis avec une fracture du col du fémur ont été inclus dans l’étude. Les variables suivantes ont été prises en compte: taux d’hémoglobine (Hb) peri-opératoire, type de fracture et de chirurgie, âge et sexe, transfusion de sang dans la période péri-opératoire.

Résultats

Il y avait 238 femmes et 72 hommes. L’âge moyen était 82.7 ans; extrêmes 53–100. Sur un total de 310 malades, 49 malades ont nécessité une transfusion de sang postopératoire. Le taux moyen de Hb pré-opératoire des malades nécessitant une transfusion était 11 (écart type 1.49); alors que le taux de ceux qui n’ont pas eu besoin de transfusion était de 12.5 (écart type 1.42). Il y avait 168 hémiarthroplasties et 142 ostéosynthèses DHS. Les malades qui eurent une DHS avaient un taux moyen pré-opératoire de Hb de 12.1 et un taux moyen post-opératoire de Hb de 9.1 La transfusion a été nécessaire chez 33 malades (23%). Les malades qui furent opérés par hémiarthroplastie avaient un taux moyen pré-opératoire de Hb de 12.4 et un taux moyen post-opératoire de Hb de 10. La transfusion a été nécessaire chez 16 malades (9.5%). L’analyse à une variable a mis en évidence une corrélation significative entre la transfusion post-opératoire et le taux de Hb pré-opératoire (P = 0.0001) et le type de fracture (= 0.001). Par contre aucun rapport n’a été trouvé entre la transfusion et l’âge (= 0.423) et le sexe du malade (= 0. 611). Le taux pré-opératoire de Hb et le type de fracture ont également été trouvés corrélés en étude à plusieurs variables.

Conclusions

Les résultats de notre étude indiquent que le facteur prédictif le plus important pour une transfusion de sang dans la fracture du col du fémur est le taux d’hémoglobine pré-opératoire, bien que le type de fracture soit aussi important. Un tri croisé réstrictif tenant compte des cas à haut risque permettrait un traitement plus adapté et éviterait le gaspillage des ressources sanguines.

Mots clés

Transfusion sanguine Fractures de hanche Facteurs prédictifs 

References

  1. 1.
    Adunsky A, Lichtenstein A, Mizrahi E, Arad M, Heim M (2003) Blood transfusion requirements in elderly hip fracture patients. Arch Gerontol Geriatr 36(1):75–81PubMedCrossRefGoogle Scholar
  2. 2.
    Amin M, Fergusson D, Aziz A et al (2003) The cost of allogenic red blood cells: a systematic review. Transfus Med 13:275–285PubMedCrossRefGoogle Scholar
  3. 3.
    Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB (1999) An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 81(1):2–10PubMedGoogle Scholar
  4. 4.
    Blumberg N, Triulzi DJ, Heal JM (1990) Transfusion-induced immunomodulation and its clinical consequences. Transfus Med Rev 4(4 Suppl 1):24–35PubMedGoogle Scholar
  5. 5.
    Carson JL, Altman DG, Duff A, Noveck H, Weinstein MP, Sonnenberg FA, Hudson JI, Provenzano G (1999) Risk of bacterial infection associated with allogeneic blood transfusion among patients undergoing hip fracture repair. Transfusion 39(7):694–700PubMedCrossRefGoogle Scholar
  6. 6.
    Cuenca J, Garcia Erce JA, Martinez AA, Solano VM, Herrera A (2004) Preoperative blood test results and type of fracture as transfusional risk factors in patients older than 65 years with trochanteric hip fracture (Spanish). Rev Esp Anestesiol Reanim 51(9):515–22PubMedGoogle Scholar
  7. 7.
    Dekutoski MB (1999) Blood loss and transfusion management in spinal surgery. Orthopedics 22(Suppl 1):s155–s157PubMedGoogle Scholar
  8. 8.
    Faris PM, Ritter MA, Abels RI (1996) The effects of recombinant human erythropoietin on perioperative transfusion requirements in patients having a major orthopaedic operation. The American Erythropoietin Study Group. J Bone Joint Surg Am 78(1):62–72PubMedGoogle Scholar
  9. 9.
    Faris PM, Spence RK, Larholt KM, Sampson AR, Frei D (1999) The predictive power of baseline hemoglobin for transfusion risk in surgery patients. Orthopedics 22(Suppl 1):s135–s140PubMedGoogle Scholar
  10. 10.
    Hill SR, Carless PA, Henry DA et al (2002) Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2:CD002042PubMedGoogle Scholar
  11. 11.
    Jaffe K (1999) Blood management challenges in orthopedic oncology. Orthopedics 22(Suppl 1):s161–s163PubMedGoogle Scholar
  12. 12.
    Kaneko K, Mogami A, Ohbayashi O, Okahara H, Iwase H, Kurosawa H (2005) Minimally invasive hemiarthroplasty in femoral neck fractures. Randomized comparison between a mini-incision: and an ordinary incision Preliminary results. Eur J Orthop Surg Traumatol 15(1):19–22CrossRefGoogle Scholar
  13. 13.
    Keating EM, Meding JB, Faris PM, Ritter MA (1998) Predictors of transfusion risk in elective knee surgery. Clin Orthop Relat Res 357:50–59PubMedCrossRefGoogle Scholar
  14. 14.
    Khan AM, Mushtaq N, Giannakas K, Sochart DH, Andrews JG (2004) Cross-match protocols for femoral neck fractures–finding one that can work. Ann R Coll Surg Engl 86(1):11–14PubMedCrossRefGoogle Scholar
  15. 15.
    Koval KJ, Rosenberg AD, Zuckerman JD, Aharonoff GB, Skovron ML, Bernstein RL, Su E, Chakka M (1997) Does blood transfusion increase the risk of infection after hip fracture? J Orthop Trauma 11(4):260–265PubMedCrossRefGoogle Scholar
  16. 16.
    Kurdy NMG, Hokan R (1993) A cross-matching policy for fractures of the proximal third of the femur. Injury 24(8):521–524PubMedCrossRefGoogle Scholar
  17. 17.
    Lemos MJ, Healy WL (1996) Blood transfusion in orthopaedic operations. J Bone Joint Surg Am 78(8):1260–1270PubMedGoogle Scholar
  18. 18.
    Levi N (1996) Blood transfusion requirements in intracapsular femoral neck fractures. Injury 27(10):709–711PubMedCrossRefGoogle Scholar
  19. 19.
    Levi N, Sandberg T (1998) Blood transfusion and postoperative wound infection in intracapsular femoral neck fractures. Bull Hosp Jt Dis 57(2):69–73PubMedGoogle Scholar
  20. 20.
    McBride DJ, Stother IG (1988) Blood transfusion requirements in elderly patients with surgically treated fractures of the femoral neck. J R Coll Surg Edinb 33(6):311–313PubMedGoogle Scholar
  21. 21.
    Muir L (1995) Blood transfusion requirements in femoral neck fractures. Ann R Coll Surg Engl 77(6):453–456PubMedGoogle Scholar
  22. 22.
    Parker MJ (1994) A cross-matching policy for fracture of the proximal third of the femur; blood transfusion and injured patients. Injury 25(7):486–487PubMedCrossRefGoogle Scholar
  23. 23.
    Sculco TP, Gallina J (1999) Blood management experience: relationship between autologous blood donation and transfusion in orthopedic surgery. Orthopedics 22(Suppl 1):s129–s134PubMedGoogle Scholar
  24. 24.
    Stowell CP, Chandler H, Jove M, Guilfoyle M, Wacholtz MC (1999) An open-label, randomized study to compare the safety and efficacy of perioperative epoetin alfa with preoperative autologous blood donation in total joint arthroplasty. Orthopedics 22(Suppl 1):s105–s112PubMedGoogle Scholar
  25. 25.
    Swain DG, Nightingale PG, Patel JV (2000) Blood transfusion requirements in femoral neck fracture. Injury 31(1):7–10PubMedCrossRefGoogle Scholar
  26. 26.
    Tietze M, Kluter H, Troch M, Kirchner H (1995) Immune responsiveness in orthopedic surgery patients after transfusion of autologous or allogeneic blood. Transfusion 35(5):378–383PubMedCrossRefGoogle Scholar
  27. 27.
    Wasson JH, Sox HC, Neff RK, Goldman L (1985) Clinical prediction rules Applications and methodological standards. N Engl J Med 313:793–799PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Arif Gul
    • 1
    • 3
    Email author
  • S. Sambandam
    • 2
  • V. Shanbhag
    • 1
  • G. Morgan
    • 1
  1. 1.Princess of Wales HospitalBridgendUK
  2. 2.Fairfield General HospitalBuryUK
  3. 3.Bangor, GwyneddUK

Personalised recommendations