Abstract
Purpose
Blood transfusions cause morbidity and complications in hip fracture patients. This includes increased risk of bacterial infection, potentially increased mortality, and higher hospital costs. Factors such as delay from admission to surgery, fracture pattern, method of fixation, operating time, age, and gender, may affect transfusion requirements. The purpose of this study was to evaluate the effect of patient and operative factors on blood loss and transfusion requirements.
Method
A retrospective analysis of 631 hip fracture patients between October 2005 and February 2010 was performed. Patients were reviewed for demographics, fracture type, fixation method, delay from admission to surgery and operating time. Patients receiving post operative blood transfusions were recorded. A logistic regression analysis was performed to establish a relationship between all independent variables and transfusion requirements.
Results
Six hundred thirty one patients met the studys inclusion criteria. There were 455 women (72.1%) and 176 men (27.9%) with a mean age of 81.6 years. There were 333 femoral neck, 252 intertrochanteric and 46 subtrochanteric fractures. The mean delay from admission to surgery was 48 hours and 54 minutes, and the average operating time was 62 minutes. Binary logistic regression revealed that delay from admisson to operation increases risk for transfusion (p<0.05). There is a 10% increased risk for every 8 hours waiting for surgery (p<0.05). Patients with subtrochanteric fractures had a higher incidence of transfusion (60.6%) compared to femoral neck (21.1%) and intertrochanteric fracture (46.3%) (p<0.05). The risk of receiving a transfusion for males was 0.53 (95% CI 0.35 to 0.81) (p<0.05). Average preoperative hemoglobin in patient who required transfusion was lower, 112.614.4 vs. 124.614.1 (p<0.05). There was a 1.60 times the risk of receiving a transfusion for every 10g/L reduction in preoperative Hb. There was no correlation between operating time and method of fixation with transfusion requirement.
Conclusion
Delay from admission to operation is a predictor for post operative transfusion requirement. Other risk factors include pre-operative haemoglobin, subtrochanteric fracture, age and female gender. This study suggests that decreasing delay will decrease transfusion requirements, which will decrease risk of infection, decrease hospital costs and potentially decrease mortality.
