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Su S, Zhang Y, Wang R, Zhou R, Chen Z, Zhou F. Early surgery within 48 h was associated with reduced perioperative blood loss and red blood cell transfusion requirements in older patients with hip fracture: a retrospective study. Eur Geriatr Med 2023; 14:1241-1248. [PMID: 37436688 DOI: 10.1007/s41999-023-00834-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/03/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE The aim of this study was to analyze the relationship between the timing of surgery and perioperative blood loss, red blood cell (RBC) transfusion rate, and RBC transfusion volume in older patients with hip fracture. METHODS From January 2020 to August 2022, this retrospective study enrolled older patients with hip fracture who underwent surgery in our hospital. The demographics, fracture type, type of surgery, time from injury to hospital, timing of surgery, medical history (hypertension, diabetes), duration of surgery, intraoperative blood loss, laboratory tests, and preoperative, postoperative and perioperative RBC transfusion requirements were recorded and analyzed. According to the surgical treatment within 48 h or after 48 h after admission, the patients were divided into early surgery group (ES) and delayed surgery group (DS). RESULTS A total of 243 older patients with hip fracture were finally included in the study. Among these, 96 patients (39.51%) underwent surgery within 48 h of admission and 147 (60.49%) underwent surgery after this time. Total blood loss (TBL) in the ES group was lower than that in the DS group (576.03 ± 265.57 ml vs 699.26 ± 380.58 ml, P = 0.003). Preoperative RBC transfusion rate, and preoperative and perioperative RBC transfusion volume in the ES group were significantly lower than those in the DS group (15.63% vs 26.53%, P = 0.046; 50.00 ± 128.15 ml vs 117.01 ± 225.85 ml, P = 0.004; 80.21 ± 196.63 ml vs 144.90 ± 253.52 ml, P = 0.027). CONCLUSION Timing of surgery within 48 h of admission for older patients with hip fracture was associated with reduced the total blood loss and RBC transfusion requirements during the perioperative period.
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Affiliation(s)
- Shilong Su
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, 100191, Beijing, China
| | - Yunqing Zhang
- Department of Orthopedics, The First Hospital of Changsha, No.311 Yingpan Road, Changsha, 410005, Hunan Province, China
| | - Ruideng Wang
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, 100191, Beijing, China
| | - Rubing Zhou
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, 100191, Beijing, China
| | - Zhengyang Chen
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, 100191, Beijing, China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, 100191, Beijing, China.
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Schweller E, Mueller J, Santiago Rivera OJ, Villegas SJ, Walkiewicz J. Factors Associated With Hip Fracture Length of Stay Among Older Adults in a Community Hospital Setting. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00004. [PMID: 37134192 PMCID: PMC10155900 DOI: 10.5435/jaaosglobal-d-22-00195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/12/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Hip fractures in geriatric populations constitute a heavy burden on the healthcare system. The study goal was to identify patient, hospital, and surgical factors associated with hospital length of stay (LOS) for geriatric patients with hip fractures requiring surgical intervention in a community hospital setting. METHODS This was a cross-sectional retrospective chart review of geriatric hip fractures that underwent surgical fixation at a community hospital between 2017 and 2019. The scope of the surgeries was limited to cephalomedullary device fixation or hemiarthroplasty hip fracture surgeries. Sliding hip screw or total hip arthroplasty procedures and patients who died during the index hospitalization were excluded. Median tests were conducted to examine differences between the groups. Unadjusted and adjusted truncated negative binomial regression models were used to examine the factors associated with LOS. RESULTS Bivariate analyses revealed results that the factors associated with a longer LOS were preoperative anemia (P = 0.029), blood transfusion (P = 0.022), and the number of days between admission and surgery (P = 0.001). The adjusted regression model results suggested that older patients, patients who underwent surgery more than one day after admission, current smokers, malnourished patients, patients with sepsis, and patients with a history of a thromboembolic event had statistically significant (P < 0.05) longer LOS. However, patients who live in institutions (nursing homes or assisted living) had a shorter LOS than those who live at home alone or with family (P < 0.05). DISCUSSION Older adult patients who underwent surgery with a cephalomedullary device or hip hemiarthroplasty for a hip fracture and had preoperative anemia, postoperative blood transfusions, and increased days between admission and surgery had a longer LOS. Additional factors positively associated with a longer LOS included current smokers, malnourishment, admission with sepsis, and patients with a history of a thromboembolic event. Of interest, institutionalized patients had a shorter LOS than those living at home alone or with family.
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Affiliation(s)
- Eric Schweller
- From the Garden City Hospital, Orthopedic Surgery Residency Program, Garden City, MI (Dr. Schweller, Dr. Mueller, and Dr. Walkiewicz); the Graduate Medical Education , Garden City Hospital, Garden City, MI (Dr. Santiago Rivera); and the Michigan State University College of Osteopathic Medicine, East Lansing, MI (Dr. Santiago Rivera and Dr. Villegas)
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Konda SR, Parola R, Perskin CR, Fisher ND, Ganta A, Egol KA. Transfusion Thresholds Can Be Safely Lowered in the Hip Fracture Patient: A Consecutive Series of 1,496 Patients. J Am Acad Orthop Surg 2023; 31:349-356. [PMID: 36727962 DOI: 10.5435/jaaos-d-22-00582] [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] [Received: 07/10/2022] [Accepted: 11/20/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The purpose of this study is to identify optimal threshold hemoglobin (Hgb) and hematocrit (Hct) laboratory values to transfuse hip fracture patients. METHODS A consecutive series of hip fracture patients were reviewed for demographic, clinical, and cost data. Patients receiving an allogeneic transfusion of packed red blood cells (pRBCs) were grouped based on last Hct or Hgb (H&H) value before first transfusion. Multivariate logistic regressions of H&H quantile were performed to predict "good outcomes," a composite binary variable defined as admissions satisfying (1) no major complications, (2) length of stay below top tertile, (3) cost below median, (4) no mortality within 30 days, and (5) no readmission within 30 days. Odds ratios (OR) for "good outcomes" were calculated for each H&H quantile. RESULTS One thousand four hundred ninety-six hip fracture patients were identified, of which 598 (40.0%) were transfused with pRBCs. Patients first transfused at Hgb values from 7.55 to 7.85 g/dL ( P = 0.043, OR = 2.70) or Hct values from 22.7 to 23.8% ( P = 0.048, OR = 2.63) were most likely to achieve "good outcomes." DISCUSSION The decision to transfuse patients should be motivated by Hgb and Hct laboratory test results, given that transfusion timing relative to surgery has been shown to not affect outcomes among patients matched by trauma risk score. Surgeons should aim to transfuse hip fracture patients at Hgb levels between 7.55 g/dL and 7.85 g/dL or Hct levels between 22.7% and 23.8%. These transfusion thresholds have the potential to lower healthcare costs without compromising quality, ultimately resulting in less costly, efficacious care for the patient. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sanjit R Konda
- From the Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY (Konda, Parola, Perskin, Fisher, Ganta, and Egol) and Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY (Konda, Ganta, and Egol)
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Pietris J. The effect of perioperative blood transfusion thresholds on patient outcomes in orthopaedic surgery: a literature review. ANZ J Surg 2022; 92:661-665. [PMID: 35180325 DOI: 10.1111/ans.17560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 01/28/2023]
Abstract
Blood transfusions are one of the most common interventions required perioperatively in orthopaedic patients. There exist two main schools of thought in relation to perioperative blood transfusion - transfusing at a haemoglobin level of 70 g/L or below (termed 'restrictive protocol' in the literature), versus transfusing at a haemoglobin threshold of 100 g/L (which the literature terms 'liberal'). Few reviews of the literature exist comparing the impact of different transfusion strategies on the postoperative outcomes of these orthopaedic patients. This review analyses the 11 currently available studies on transfusion protocols in orthopaedics and associated findings related to patient outcomes. The literature showed no clear consensus on whether one transfusion protocol is superior in the orthopaedic patient. There was strong evidence for reduced transfusion rates among groups receiving transfusion at <70 g/L, and hence a reduction in complication directly related to transfusions. Despite this, other measured patient outcomes, including length of stay, postoperative complication rate, and mortality rate, were unchanged between the groups. Some evidence exists that a Hb threshold of 100 g/L results in earlier postoperative ambulation in hip surgery patients. One study suggests using preoperative haemoglobin as a preoperative risk factor to aid in determining whether patients are more suited to one approach over the other. Further high-quality clinical trials in orthopaedic cohorts must become available to determine whether a haemoglobin threshold of 70 g/L can safely be adopted to reduce transfusion rates without adversely impacting patient outcomes.
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Affiliation(s)
- James Pietris
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Fazal MA, Shah A, Mohamed FY, Hassan R. Postoperative haemoglobin estimation in elderly hip fractures. Aging Med (Milton) 2021; 4:175-179. [PMID: 34553114 PMCID: PMC8444953 DOI: 10.1002/agm2.12172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The purpose of our study was to analyze the effect of postoperative hemoglobin check on the day of surgery and 1 day postoperatively in elderly hip fracture patients with an aim to determine an optimum timing of postoperative hemoglobin check. MATERIAL AND METHODS A retrospective study of 253 patients. Age, Charlson morbidity index, fracture type, time from admission to surgery, type of surgery, preoperative hemoglobin, postoperative hemoglobin, hemoglobin drop, day of postoperative hemoglobin measurement, blood transfusion, length of hospital stay, and 30-day mortality were recorded. RESULTS One hundred and sixty-three patients (Group I) had postoperative hemoglobin check on the first postoperative day and 90 patients (Group II) on the day of surgery. Mean age in Group I was 82 years and 80 years in Group II. Mean Charlson morbidity index for Group I was 5.9 and Group II was 5.7. There was a significantly higher hemoglobin drop in Group I (P < 0.05) but no difference in blood transfusion requirement, length of stay, or 30-day mortality in the two groups (P > 0.05). CONCLUSION Our results suggest that postoperative hemoglobin measurement on the day of surgery is not a true reflection of hemoglobin drop and recommend estimation of hemoglobin on the first postoperative day.
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Affiliation(s)
- Muhammad Ali Fazal
- Department of Trauma and OrthopaedicsRoyal Free London NHS Foundation TrustLondonUK
| | - Anand Shah
- Department of Trauma and OrthopaedicsRoyal Free London NHS Foundation TrustLondonUK
| | - Foad Y. Mohamed
- Department of Trauma and OrthopaedicsRoyal Free London NHS Foundation TrustLondonUK
| | - Raza Hassan
- Department of Trauma and OrthopaedicsRoyal Free London NHS Foundation TrustLondonUK
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Zhao H, You J, Peng Y, Feng Y. Machine Learning Algorithm Using Electronic Chart-Derived Data to Predict Delirium After Elderly Hip Fracture Surgeries: A Retrospective Case-Control Study. Front Surg 2021; 8:634629. [PMID: 34327210 PMCID: PMC8313764 DOI: 10.3389/fsurg.2021.634629] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Elderly patients undergoing hip fracture repair surgery are at increased risk of delirium due to aging, comorbidities, and frailty. But current methods for identifying the high risk of delirium among hospitalized patients have moderate accuracy and require extra questionnaires. Artificial intelligence makes it possible to establish machine learning models that predict incident delirium risk based on electronic health data. Methods: We conducted a retrospective case-control study on elderly patients (≥65 years of age) who received orthopedic repair with hip fracture under spinal or general anesthesia between June 1, 2018, and May 31, 2019. Anesthesia records and medical charts were reviewed to collect demographic, surgical, anesthetic features, and frailty index to explore potential risk factors for postoperative delirium. Delirium was assessed by trained nurses using the Confusion Assessment Method (CAM) every 12 h during the hospital stay. Four machine learning risk models were constructed to predict the incidence of postoperative delirium: random forest, eXtreme Gradient Boosting (XGBoosting), support vector machine (SVM), and multilayer perception (MLP). K-fold cross-validation was deployed to accomplish internal validation and performance evaluation. Results: About 245 patients were included and postoperative delirium affected 12.2% (30/245) of the patients. Multiple logistic regression revealed that dementia/history of stroke [OR 3.063, 95% CI (1.231, 7.624)], blood transfusion [OR 2.631, 95% CI (1.055, 6.559)], and preparation time [OR 1.476, 95% CI (1.170, 1.862)] were associated with postoperative delirium, achieving an area under receiver operating curve (AUC) of 0.779, 95% CI (0.703, 0.856). The accuracy of machine learning models for predicting the occurrence of postoperative delirium ranged from 83.67 to 87.75%. Machine learning methods detected 16 risk factors contributing to the development of delirium. Preparation time, frailty index uses of vasopressors during the surgery, dementia/history of stroke, duration of surgery, and anesthesia were the six most important risk factors of delirium. Conclusion: Electronic chart-derived machine learning models could generate hospital-specific delirium prediction models and calculate the contribution of risk factors to the occurrence of delirium. Further research is needed to evaluate the significance and applicability of electronic chart-derived machine learning models for the detection risk of delirium in elderly patients undergoing hip fracture repair surgeries.
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Affiliation(s)
- Hong Zhao
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Jiaming You
- Key laboratory of Universal Wireless Communication lab, Ministry of Education, Beijing University of Posts and Telecommunications, Beijing, China
| | - Yuexing Peng
- Key laboratory of Universal Wireless Communication lab, Ministry of Education, Beijing University of Posts and Telecommunications, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
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Parola R, Konda SR, Perskin CR, Ganta A, Egol KA. Transfusion timing relative to surgery does not impact outcomes in hip fracture patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:725-732. [PMID: 34106338 DOI: 10.1007/s00590-021-03033-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study is to determine the effects of blood transfusion timing in hip fracture patients. METHODS A consecutive series of hip fracture patients 55 years and older who required a blood transfusion during hospitalization were reviewed for demographic, injury, clinical outcome, and cost information. A validated risk predictive score (STTGMA) was calculated for each patient. Patients were stratified to preoperative, intraoperative, or postoperative first transfusion cohorts. The intraoperative and postoperative cohorts were matched by STTGMA, sex, and procedure to the preoperative cohort. Baseline patient characteristics and outcomes were compared before and after matching. RESULTS Prior to matching, the preoperative cohort was more often male (p < 0.001) with increased Charlson comorbidity index (p = 0.012), ASA class (p < 0.002), STTGMA (p < 0.001), total transfused volume (p = 0.002), incidence of inpatient mortality (p = 0.045), myocardial infarction (p = 0.005) and cardiac arrest (p = 0.014). After matching, the preoperative cohort had increased total transfused volume (p = 0.015) and decreased pneumonia incidence (p = 0.040). CONCLUSION Matching STTGMA score, sex, and procedure results in non-inferior outcomes among hip fracture patients receiving preoperative first blood transfusions compared to intraoperative and postoperative transfusions.
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Affiliation(s)
- Rown Parola
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.,Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, USA
| | - Cody R Perskin
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.,Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, USA
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA. .,Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, USA.
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Gupta P, Kang KK, Pasternack JB, Klein E, Feierman DE. Perioperative Transfusion Associated With Increased Morbidity and Mortality in Geriatric Patients Undergoing Hip Fracture Surgery. Geriatr Orthop Surg Rehabil 2021; 12:21514593211015118. [PMID: 34035979 PMCID: PMC8132085 DOI: 10.1177/21514593211015118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Both conservative and liberal transfusion thresholds, in regard to hematocrit and hemoglobin levels, have been widely studied with varying outcomes. The aim of this study was to evaluate if transfusion administered peri- (anytime during the admission), pre-, intra-, or postoperatively an its association with morbidity and mortality in the geriatric population undergoing hip surgery. Methods: This study was an institutional review board approved retrospective analysis of data collected from 841 patients at a single urban institution who underwent surgical repairs for hip fractures from 2008 to 2010. Results: Our analysis included data from 841 surgical patients. Mean patient age was 83, 74% were female, 48% received spinal anesthesia while 52% underwent general anesthesia. Out of 841 patients, 425 were transfused during the perioperative period. Most transfusions occurred postoperatively. Perioperative, intraoperative and postoperative transfusion was associated with an increase in post-operative AKI. Intraoperative blood transfusion was associated with an increase in morbidity (11.6% increased to 22.2%) by 1.9 fold, AKI (3.9% increased to 11.1%) by 2.8 fold, as well as an increase in mortality (5.2 increased to 15.6%) within 60 days by 3 fold. Conclusions: This may suggest that patients transfused prior to surgery, despite having met a specific trigger hemoglobin level earlier, may have been treated before deteriorating to a point that would cause future systemic implications.
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Affiliation(s)
- Piyush Gupta
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Kevin K Kang
- Department of Orthopedics, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Elliot Klein
- Department of Anesthesiology, Donald and Barbara Zucker School of Medicine at Hofstra, Queens NY, USA
| | - Dennis E Feierman
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA
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Yang YF, Huang JW, Gao XS, Liu ZL, Wang JW, Xu ZH. The Correlation Between Timing of Surgery and the Need for RBC Transfusions in the Geriatric Intertrochanteric Fracture Population. Geriatr Orthop Surg Rehabil 2021; 12:2151459321998614. [PMID: 33717635 PMCID: PMC7917848 DOI: 10.1177/2151459321998614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 01/27/2023] Open
Abstract
Objective: To identify whether the timing of surgery affects red blood cell (RBC)
transfusion requirements in the elderly with intertrochanteric
fractures. Methods: We retrospectively studied all patients undergoing surgical fixation of their
intertrochanteric fractures in our hospital between January 2009 and
December 2018 and analyzed the relationship between the timing of surgery
and RBC transfusion. Results: A total of 679 patients were included in this study. The need for RBC
transfusion was lower in the patients who underwent surgery within 12 h
after admission (timing of surgery <12 h, <12 h group) than those who
underwent surgery over 12 h after admission (timing of surgery >12 h,
>12 h group) (P = 0.046); lower in the the patients who underwent surgery
within 24 h after admission (timing of surgery <24 h, <24 h group)
than in those who underwent surgery over 24 h after admission (timing of
surgery >24 h, >24 h group) (P = 0.008), and lower in the <24 h
group compared to the patients who underwent surgery within 48 h after
admission (timing of surgery <48 h, <48 h group) (P = 0.035).
Moreover, the need for RBC transfusion was lower in the <24 h group (in
the first 24 h from admission to surgery) than in the 24-48 h group (in the
second 24 h from admission to surgery) (P = 0.016), and also lower in the
<24 h group compared to the 48-72 h group (in the third 24 h from
admission to surgery) (P = 0.047). However, there were no differences
between the <12 h group and 12-24 h group, between the <12 h group and
<24 h group, and between the 12-24 h group and <24 h group,
respectively. Conclusion: Timing of surgery within 24 h contributes to the reduction of RBC transfusion
in the elderly with intertrochanteric fractures.
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Affiliation(s)
- Yun-Fa Yang
- Guangzhou First People's Hospital, Guangzhou, China
| | | | | | - Zai-Li Liu
- Guangzhou First People's Hospital, Guangzhou, China
| | | | - Zhong-He Xu
- Guangzhou First People's Hospital, Guangzhou, China
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Improving peri-operative outcome: Time once more to update protocols. Eur J Anaesthesiol 2020; 37:625-628. [PMID: 32073410 DOI: 10.1097/eja.0000000000001168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhu C, Yin J, Wang B, Xue Q, Gao S, Xing L, Wang H, Liu W, Liu X. Restrictive versus liberal strategy for red blood-cell transfusion in hip fracture patients: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16795. [PMID: 31393409 PMCID: PMC6708976 DOI: 10.1097/md.0000000000016795] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Most clinical guidelines recommend a restrictive red-blood-cell (RBC) transfusion threshold. However, indications for transfusion in patients with a hip fracture have not been definitively evaluated or remain controversial. We compared the pros and cons of restrictive versus liberal transfusion strategies in patients undergoing hip fracture surgery. METHODS Electronic databases were searched to identify randomized controlled trials (RCTs) and retrospective cohort studies (RCSs) to investigate the effects of a restrictive strategy versus its liberal counterpart in patients undergoing hip fracture surgery. The main clinical outcomes included delirium, mortality, infections, cardiogenic complications, thromboembolic events, cerebrovascular accidents, and length of hospital stay. The meta-analysis program of the Cochrane Collaboration (RevMan version 5.3.0) was used for data analysis. Statistical heterogeneity was assessed by both Cochran chi-squared test (Q test) and I test. Both Begg and Egger tests were used to assess potential publication bias. RESULTS We identified 7 eligible RCTs and 2 eligible RCSs, involving 3,575 patients in total. In patients undergoing hip fracture surgery, we found no differences in frequency of delirium, mortality, the incidence rates of all infections, pneumonia, wound infection, all cardiovascular events, congestive heart failure, thromboembolic events or length of hospital stay between restrictive and liberal thresholds for RBC transfusion (P >.05). However, we found that the use of restrictive transfusion thresholds is associated with higher rates of acute coronary syndrome (P <.05) while liberal transfusion thresholds increase the risk of cerebrovascular accidents (P <.05). CONCLUSION In patients undergoing hip fracture surgery, clinicians should evaluate the patient's condition in detail and adopt different transfusion strategies according to the patient's specific situation rather than merely using a certain transfusion strategy.
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Affiliation(s)
| | | | | | | | | | - Linyu Xing
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, People's Republic of China
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