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Farrow L, Brasnic L, Martin C, Ward K, Adam K, Hall AJ, Clement ND, MacLullich AMJ. A nationwide study of blood transfusion in hip fracture patients. Bone Joint J 2022; 104-B:1266-1272. [DOI: 10.1302/0301-620x.104b11.bjj-2022-0450.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to examine perioperative blood transfusion practice, and associations with clinical outcomes, in a national cohort of hip fracture patients. Methods A retrospective cohort study was undertaken using linked data from the Scottish Hip Fracture Audit and the Scottish National Blood Transfusion Service between May 2016 and December 2020. All patients aged ≥ 50 years admitted to a Scottish hospital with a hip fracture were included. Assessment of the factors independently associated with red blood cell transfusion (RBCT) during admission was performed, alongside determination of the association between RBCT and hip fracture outcomes. Results A total of 23,266 individual patient records from 18 hospitals were included. The overall rate of blood transfusion during admission was 28.7% (n = 6,685). There was inter-hospital variation in transfusion rate, ranging from 16.6% to 37.4%. Independent perioperative factors significantly associated with RBCT included older age (90 to 94 years, odds ratio (OR) 3.04 (95% confidence interval (CI) 2.28 to 4.04); p < 0.001), intramedullary fixation (OR 7.15 (95% CI 6.50 to 7.86); p < 0.001), and sliding hip screw constructs (OR 2.34 (95% CI 2.19 to 2.50); p < 0.001). Blood transfusion during admission was significantly associated with higher rates of 30-day mortality (OR 1.35 (95% CI 1.19 to 1.53); p < 0.001) and 60-day mortality (OR 1.54 (95% CI 1.43 to 1.67); p < 0.001), as well as delays to postoperative mobilization, higher likelihood of not returning to their home, and longer length of stay. Conclusion Blood transfusion after hip fracture was common, although practice varied nationally. RBCT is associated with adverse outcomes, which is most likely a reflection of perioperative anaemia, rather than any causal effect. Use of RBCT does not appear to reverse this effect, highlighting the importance of perioperative blood loss reduction. Cite this article: Bone Joint J 2022;104-B(11):1266–1272.
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Affiliation(s)
- Luke Farrow
- Institute of Applied Health Sciences, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK
- Grampian Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Lorena Brasnic
- Institute of Applied Health Sciences, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK
| | - Caroline Martin
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Kirsty Ward
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Karen Adam
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Andrew J. Hall
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK
| | - Nick D. Clement
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alasdair M. J. MacLullich
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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OLIVEIRA JOSÉALBERTOALVES, BRITO GABRIELLACRISTINACOELHODE, BEZERRA FRANCISCAMAGNAPRADO, CARVALHO NETO CARLOSALFREDODE, ALENCAR NETO JONATASBRITODE, IBIAPINA ROBERTOCÉSARPONTES. THE USE OF ANTIFIBRINOLYTICS IN HIP TRAUMA SURGERY IN A PUBLIC HEALTH SYSTEM: A PROSPECTIVE STUDY. ACTA ORTOPEDICA BRASILEIRA 2021; 29:304-307. [PMID: 34849094 PMCID: PMC8601384 DOI: 10.1590/1413-785220212906244502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/09/2020] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the use of tranexamic acid (TXA) and ε-aminocaproic acid (EACA) in reducing blood loss in hip and proximal femur trauma surgery. Methods: Prospective study with 49 patients surgically treated in a trauma hospital between Nov/2015 and Feb/2017. The patients were divided in two groups: TXA (n = 24) and EACA (n = 25). The comparison was made according to gender, age at the time of surgery, ASA, fracture and surgery type, estimated blood loss during surgical approach, hemoglobin and hematocrit levels pre and post-operative, and pharmacological cost. The data was processed using SPSS 22.0 with significance level of p < 0,05. Results: No significant difference was found in the variables age, gender, ASA and estimated blood loss during surgical approach. No patient needed blood transfusion. When evaluated post-operatively, the hemoglobin and hematocrit values decrease had no significant difference between the antifibrinolytics (p > 0.05). When analyzing total cost for both pharmacological agents, higher cost was observed in EACA than in TXA (US$ 16.09 - US$ 2.73), resulting in a US$ 13.36 addition per patient. Conclusion: Antifibrinolytic use was efficient on lowering the total blood loss, without the need of blood transfusion. Level of evidence II, Prospective Comparative Study.
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