Acta Ortopédica Mexicana

Torres-Campos A, Floria-Arnal LJ, Muniesa-Herrero MP, Ranera-García M, Osca-Guadalajara M, Castro-Sauras A
Initial hemoglobin value as a predictor of allogeneic blood transfusion in hip fracture
Acta Ortop Mex 2018; 32 (6)

Language: Español
References: 23
Page: 347-353
PDF: 215.43 Kb.

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ABSTRACT

Introduction: Hip fracture is a cause of major morbidity and mortality and is often associated with high blood transfusion rate, non-complication-free therapy. The objective of the study is to evaluate the factors dependent and independent of the transfusional act, as well as to elaborate an algorithm that allows us to make a decision making based on a statistical model rationalizing the use of blood. Material and methods: Prospective study on 100 patients older than 65 years intervened for hip fracture consecutively. We analyzed demographic data, drug taking, comorbidity, pre- and postoperative analytics, type of fracture and those related to surgery valuing uni- and bivariate determinants of the Transfusional Act to control the possible bias of confusion. Results: Following the application of the bivariate logistic regression model only the HB at the admission (p = 0.04, or = 0.451) and the type of fracture (p = 0.003, or = 5.479) were considered associated with the transfusion act. The value of initial HB generates a ROC curve with an area under the curve of 0.848, acceptable to assess the probability of transfusion. An initial HB value lower of 12.15 g/dl will predict the transfusion with a sensitivity of 80% and a specificity of 85%. Conclusion: The presence of preoperative anemia and extracapsular hip fractures generate a high risk of transfusion need, while it is unlikely in intracapsular fractures without anemia at admission. In our series there is an analytical value that predicts satisfactorily 80% of blood transfusions.


Key words: Hip fracture, hemoglobin, transfusion, risk factor.


REFERENCES

  1. Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009; 170(10): 1290-9.

  2. Swain DG, Nightingale PG, Patel JV. Blood transfusion requirements in femoral neck fracture. Injury. 2000; 31(1): 7-10.

  3. Lawrence VA, Silverstein JH, Cornell JE, Pederson T, Noveck H, Carson JL. Higher Hb level is associated with better early functional recovery after hip fracture repair. Transfusion. 2003; 43(12): 1717-22.

  4. Halm EA, Wang JJ, Boockvar K, Penrod J, Silberzweig SB, Magaziner J, et al. The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture. J Orthop Trauma. 2004; 18(6): 369-74.

  5. Cuenca J, Martínez A, García Arce JA, Malillos M, Herrera A. Necesidades transfusionales en fracturas trocantéreas tratadas con el sistema extramedular tornillo-placa deslizante de cadera (DHS®). Rev Esp Cir Osteoart. 2004; 39: 125-31.

  6. Johnston P, Wynn-Jones H, Chakravarty D, Boyle A, Parker MJ. Is perioperative blood transfusion a risk factor for mortality or infection after hip fracture? J Orthop Trauma. 2006; 20(10): 675-9.

  7. Goognough LT, Ridell J 4th, Verbrugge D, Marcus RE. Blood transfusions in hip fracture patients: implications for blood conservation programs. J Orthop Trauma. 1993; 7(1): 47-51.

  8. Muñoz M, Leal-Noval SR. Restrictive transfusion triggers in major orthopaedic surgery: effective and safe? Blood Transfus. 2013; 11(2): 169-71.

  9. Quijada JL, Hurtado P, de Lamo J. Factores que incrementan el riesgo de transfusión sanguínea en los pacientes con fractura de cadera. Rev Esp Cir Ortop Traumatol. 2011; 55(1): 35-8.

  10. Manning BJ, O’Brien N, Aravindan S, Cahill RA, McGreal G, Redmond HP. The effect of aspirin on blood loss and transfusion requirements in patients with femoral neck fractures. Injury. 2004; 35(2): 121-4.

  11. Chechik O, Thein R, Fichman G, Haim A, Tov TB, Steinberg EL. The effect of clopidogrel and aspirin on blood loss in hip fracture surgery. Injury. 2011; 42(11): 1277-82.

  12. Dillon MF, Collins D, Rice J, Murphy PG, Nicholson P, Mac Elwaine J. Preoperative characteristics identify patients with hip fractures at risk of transfusion. Clin Orthop Relat Res. 2005; 439: 201-6.

  13. Al-Ani AN, Samuelsson B, Tidermark J, Norling A, Ekström W, Cederholm T, et al. Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg. 2008; 90-A: 1436-42.

  14. Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J, Otto DD, et al. Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res. 2005; 20(3): 494-500.

  15. Carson JL, Altman DG, Duff A, Noveck H, Weinstein MP, Sonnenberg FA, et al. Risk of bacterial infection associated with allogeneic blood transfusion among patients undergoing hip fracture repair. Transfusion. 1999; 39(7): 694-700.

  16. Foss NB, Kristensen MT, Jensen PS, Palm H, Krasheninnikoff M, Kehlet H. The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery. Transfusion. 2009; 49(2): 227-34.

  17. Adunsky A, Lichtenstein A, Mizrahi E, Arad M, Heim M. Blood transfusion requirements in elderly hip fracture patients. Arch Gerontol Geriatr. 2003; 36(1): 75-81.

  18. Shokoohi A, Stanworth S, Mistry D, Lamb S, Staves J, Murphy MF. The risks of red cell transfusion for hip fracture surgery in the elderly. Vox Sang. 2012; 103(3): 223-30.

  19. Kumar D, Mbako A N, Riddick A, Patil S, Williams P. On admission haemoglobin in patients with hip fracture. Injury. 2011; 42(2): 167-70.

  20. Cuenca J, Martínez AA, Panisello JJ, Herrera A, Sola A. Estudio de la evolución de la hemoglobina y el hematocrito según el tipo de fractura de cadera. Rev Ortop Traumatol. 2002; 46(1): 54-7.

  21. Kadar A, Chechik O, Steinberg E, Reider E, Sternheim A. Predicting the need for blood transfusion in patients with hip fractures. Int Orthop. 2013; 37(4): 693-700.

  22. Carless PA, Henry DA, Carson JL, Hebert PP, McClelland B, Ker K. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2010; 6 (10): CD002042.

  23. Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011; 365(26): 2453-62.