Blood-Transfusion Risk Factors After Intramedullary Nailing for Extracapsular Femoral Neck Fracture in Elderly Patients

Overview

Journal J Funct Morphol Kinesiol

Date 2023 Feb 22

PMID 36810511

Authors

Gianluca Testa

Marco Montemagno

Andrea Vescio

Giuseppe Micali

Rosario Perrotta

Francesco Lacarrubba

Teresio Avitabile

Guido Basile

Vito Pavone

Affiliations

Soon will be listed here.

Abstract

Background: Extracapsular femoral neck fractures (eFNF) are the third most common type of fracture in traumatology. Intramedullary nailing (IMN) is one of the most frequently used ortho-pedic treatments for eFNF. Blood loss is one of the main complications of this treatment. This study aimed to identify and evaluate the perioperative risk factors that lead to blood transfusion in frail patients with eFNF who undergo IMN.

Methods: From July 2020 to December 2020, 170 eFNF-affected patients who were treated with IMN were enrolled and divided into two groups according to blood transfusion: NBT (71 patients who did not need a blood transfusion), and BT (72 patients who needed blood transfusion). Gender, age, BMI, pre-operative hemoglobin levels, in-ternational normalized ratio (INR) level, number of blood units transfused, length of hospital stay, surgery duration, type of anesthesia, pre-operative ASA score, Charlson Comorbidity Index, and mortality rate were assessed.

Results: Cohorts differed only for pre-operatively Hb and surgery time ( < 0.05).

Conclusion: Patients who have a lower preoperative Hb level and longer surgery time have a high blood-transfusion risk and should be closely followed peri-operatively.

Citing Articles

Special Issue "Working Group in Sports Medicine".

Musumeci G J Funct Morphol Kinesiol. 2025; 10(1.

PMID: 39846653 PMC: 11755619. DOI: 10.3390/jfmk10010012.

Establishment of a predictive model for blood transfusion after femoral head replacement in elderly patients.

Zhang Y, Dai J, Tang X, Ma J Jt Dis Relat Surg. 2024; 35(3):538-545.

PMID: 39189562 PMC: 11411888. DOI: 10.52312/jdrs.2024.1786.

Post-surgery interventions for hip fracture: a systematic review of randomized controlled trials.

Phang J, Lim Z, Yee W, Tan C, Kwan Y, Low L BMC Musculoskelet Disord. 2023; 24(1):417.

PMID: 37231406 PMC: 10210378. DOI: 10.1186/s12891-023-06512-9.

References

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. DOI: 10.1016/s0167-4943(02)00059-6. View

Lin P, Chien J, Hung J, Hong C, Tsai T, Yang C . Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study. BMC Musculoskelet Disord. 2020; 21(1):244. PMC: 7158073. DOI: 10.1186/s12891-020-03208-2. View

Luo X, He S, Li Z, Li Q . Quantification and influencing factors of perioperative hidden blood loss during intramedullary fixation for intertrochanteric fractures in the elderly. Arch Orthop Trauma Surg. 2019; 140(10):1339-1348. DOI: 10.1007/s00402-019-03311-7. View

Quach L, Jayamaha S, Whitehouse S, Crawford R, Pulle C, Bell J . Comparison of the Charlson Comorbidity Index with the ASA score for predicting 12-month mortality in acute hip fracture. Injury. 2020; 51(4):1004-1010. DOI: 10.1016/j.injury.2020.02.074. View

Zheng H, Zhang Y, Wang H, Sun T, Sun Q . Comparison of perioperative hidden blood loss for intertrochanteric fractures in the elderly by different intramedullary fixations: A randomized controlled study protocol. Medicine (Baltimore). 2020; 99(48):e21666. PMC: 7710182. DOI: 10.1097/MD.0000000000021666. View

DAmore T, Loewen M, Gorczyca M, Judd K, Ketz J, Soles G . Rethinking strategies for blood transfusion in hip fracture patients. OTA Int. 2021; 3(3):e083. PMC: 8023119. DOI: 10.1097/OI9.0000000000000083. View

Cai L, Wang T, Di L, Hu W, Wang J . Comparison of intramedullary and extramedullary fixation of stable intertrochanteric fractures in the elderly: a prospective randomised controlled trial exploring hidden perioperative blood loss. BMC Musculoskelet Disord. 2016; 17(1):475. PMC: 5109735. DOI: 10.1186/s12891-016-1333-z. View

Mattisson L, Lapidus L, Enocson A . What Is the Influence of a Delay to Surgery >24 Hours on the Rate of Red Blood Cell Transfusion in Elderly Patients With Intertrochanteric or Subtrochanteric Hip Fractures Treated With Cephalomedullary Nails?. J Orthop Trauma. 2018; 32(8):403-407. DOI: 10.1097/BOT.0000000000001183. View

Hoffmann M, Khoriaty J, Sietsema D, Jones C . Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures. J Orthop Surg Res. 2019; 14(1):360. PMC: 6852997. DOI: 10.1186/s13018-019-1431-3. View

10.

Roberts K, Brox W, Jevsevar D, Sevarino K . Management of hip fractures in the elderly. J Am Acad Orthop Surg. 2015; 23(2):131-7. DOI: 10.5435/JAAOS-D-14-00432. View

11.

Yombi J, Putineanu D, Cornu O, Lavandhomme P, Cornette P, Castanares-Zapatero D . Low haemoglobin at admission is associated with mortality after hip fractures in elderly patients. Bone Joint J. 2019; 101-B(9):1122-1128. DOI: 10.1302/0301-620X.101B9.BJJ-2019-0526.R1. View

12.

Hart A, Abou Khalil J, Carli A, Huk O, Zukor D, Antoniou J . Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am. 2014; 96(23):1945-51. DOI: 10.2106/JBJS.N.00077. View

13.

Clegg A, Young J, Iliffe S, Rikkert M, Rockwood K . Frailty in elderly people. Lancet. 2013; 381(9868):752-62. PMC: 4098658. DOI: 10.1016/S0140-6736(12)62167-9. View

14.

Keene G, Parker M, Pryor G . Mortality and morbidity after hip fractures. BMJ. 1993; 307(6914):1248-50. PMC: 1679389. DOI: 10.1136/bmj.307.6914.1248. View

15.

Arshi A, Lai W, Iglesias B, McPherson E, Zeegen E, Stavrakis A . Blood transfusion rates and predictors following geriatric hip fracture surgery. Hip Int. 2020; 31(2):272-279. DOI: 10.1177/1120700019897878. View

16.

Lamb J, Panteli M, Pneumaticos S, Giannoudis P . Epidemiology of pertrochanteric fractures: our institutional experience. Eur J Trauma Emerg Surg. 2016; 40(3):225-32. DOI: 10.1007/s00068-014-0375-x. View

17.

Greenhalgh M, Gowers B, Iyengar K, Adam R . Blood transfusions and hip fracture mortality - A retrospective cohort study. J Clin Orthop Trauma. 2021; 21:101506. PMC: 8326716. DOI: 10.1016/j.jcot.2021.101506. View

18.

Johnston P, Wynn-Jones H, Chakravarty D, Boyle A, Parker M . Is perioperative blood transfusion a risk factor for mortality or infection after hip fracture?. J Orthop Trauma. 2006; 20(10):675-9. DOI: 10.1097/01.bot.0000249435.25751.e8. View

19.

Walsh M, Preston C, Bong M, Patel V, Di Cesare P . Relative risk factors for requirement of blood transfusion after total hip arthroplasty. J Arthroplasty. 2007; 22(8):1162-7. DOI: 10.1016/j.arth.2006.10.014. View

20.

Guo J, Zhang Y, Hou Z . Intramedullary Fixation Does Not Cause a Large Amount of Hidden Blood Loss in Elderly Patients with Intertrochanteric Fractures. Clin Interv Aging. 2021; 16:475-486. PMC: 7982444. DOI: 10.2147/CIA.S301737. View