Risk Factors for Perioperative Hidden Blood Loss After Intertrochanteric Fracture Surgery in Chinese Patients: A Meta-Analysis

Application of the "3-2-1" body surface localization method in intertrochanteric femoral fractures: a technical note

In femoral intertrochanteric fractures, poor incision positioning may result in inaccurate intramedullary nail placement direction, which increases the difficulty of reduction and thus the size and number of incisions. Repeated intraoperative fluoroscopy not only increases the radiation exposure of the surgeon but also affects the operative outcomes. This technical note proposes a method of identifying incision positioning preoperatively using the "3-2-1" body surface localization method. This auxiliary positioning technique uses a body surface locator and the lower limb force axis. It can predict the incisions for the needle insertion point, spiral blade, and locking nails, create minimally invasive incisions, avoid incorrect incision position, facilitate accurate intraoperative intramedullary nail placement, reduce the incision size, intraoperative bleeding, and radiation exposure, and improve surgical efficiency and reduction quality.

Risk Factors Analysis and Nomogram Model Establishment of Hidden Blood Loss in Overweight and Obese Elderly Patients After Total Hip Arthroplasty

Background

Total hip arthroplasty (THA) has become the first-choice treatment for elderly patients with end-stage hip disease. The high amount of hidden blood loss (HBL) in overweight and obese patients after THA not only affects rapid recovery, but also results in a greater economic burden. We aimed to identify risk factors that contribute to elevated HBL in overweight and obese patients after THA by retrospective analysis, and establish a nomogram prediction model for massive HBL in overweight and obese patients after THA.

Methods

A total of 505 overweight and obese patients treated with THA were included and randomly divided into modeling and validation sets according to a 7:3 ratio. The demographic and relevant clinical data of the patients were collected. The independent risk factors affecting HBL after THA in overweight and obese patients were obtained by Pearson, independent sample T-test, and multiple linear regression analyses. R software was used to establish a nomogram prediction model for postoperative HBL, as well as a receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).

Results

HBL was 911±438 mL, accounting for 79.5±13.1% of the total perioperative blood loss (1104±468 mL). A multiple linear regression analysis showed that HBL was associated with necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels. The areas under the ROC curve (AUC) for the modeling and validation sets were 0.751 and 0.736, respectively, while the slope of the calibration curve was close to 1. The DCA curve demonstrated a better net benefit at a risk of HBL ≥1000 ml in both the training and validation groups.

Conclusion

HBL was an important component of total blood loss (TBL) after THA in overweight and obese patients. Necrosis of the femoral head, absence of hypertension, longer operative time, higher preoperative erythrocytes, and higher preoperative D-dimer levels were independent risk factors for postoperative HBL in these patients. The predictive model constructed based these data had better discriminatory power and accuracy, and could result in better net benefit for patients.

Association between fracture type and the risk of bleeding in intertrochanteric femur fractures

Introduction

The current study aimed to determine the association between fracture type and pre-operative hemoglobin level decrease in intertrochanteric fractures. Further, the erythrocyte unit required in replacement therapy until discharge according to fracture type was evaluated.

Patients and methods

We retrospectively analyzed 194 patients diagnosed with intertrochanteric femur fracture who received proximal femoral nail implantation. Among them, 122 met the inclusion criteria, and they were divided into group 1 (stable fracture) and group 2 (unstable fracture) according to the Arbeitsgemeinschaft für Osteosynthesefragen classification. Data on age, sex, fracture side, surgical waiting time, pre- and post-operative hemoglobin levels, and total erythrocyte units required were assessed. Then, statistical analysis was performed.

Results

The stable and unstable groups were similar in terms of age, sex, fracture side, and surgical waiting time (p > 0.05). The average erythrocyte units required in replacement therapy were 1.62 (total: 96) in group 2 and 0.91 (total: 57) in group 1. Moreover, group 2 was more likely to require eythrocyte replacement than group 1 (p = 0.001). The average hemoglobin level decreases were 1.70 g/dL in group 1 and 1.95 g/dL in group 2. The pre-operative hemoglobin level decrease had a similar distribution in both groups (p = 0.239).

Conclusions

The pre-operative blood loss volume was similar between unstable and stable intertrochanteric fractures. Moreover, at unstable group, the need for erythrocyte replacement therapy was high in the whole period until discharge.

The hidden blood loss and its factors in patients undergoing minimally invasive knee arthroscopy

Background

With respect to knee arthroscopy, assessing the amount of hidden blood loss is of great importance to avoid potential complications such as fever, anemia, difficulty in wound healing and wound infection. The current study aims to investigate the hidden blood loss and its factors in patients who underwent minimally invasive knee arthroscopy.

Methods

Consecutive patients with knee joint injury, who underwent arthroscopic minimally invasive treatment, were enrolled from January 2019 to November 2020 and were retrospectively studied. Demographic information on these patients, such as medical history and biochemical parameters, was collected. The hidden blood loss was calculated. Multivariate linear regression analysis was used to confirm independent factors associated with hidden blood loss.

Results

Finally, a total of 100 patients aged 44.78 ± 13.67 (range 17–66) years were reviewed, and it was found that a substantial amount of [387.02 ± 252.56 (range 18.89–1130.06) ml] hidden blood loss occurred after minimally invasive knee arthroscopy. Univariate analysis showed that this hidden blood loss was negatively correlated with age, gender, postoperative hemoglobin, and postoperative hematocrit (all P < 0.05), while it was positively correlated with body mass index (BMI), length of hospital stay, preoperative red blood cells, preoperative hemoglobin, preoperative hematocrit, blood volume, and the presence of medical conditions (all P < 0.05). Further multivariate linear regression indicated that preoperative hematocrit, blood volume, and postoperative hematocrit were independent factors associated with actual blood loss, and preoperative hematocrit, blood volume, postoperative hematocrit, and gender were independent factors associated with hidden blood loss, respectively (all P < 0.05).

Conclusion

Preoperative hematocrit, preoperative blood volume, postoperative hematocrit, and gender are the influencing factors of hidden blood loss in patients undergoing minimally invasive treatment under knee arthroscopy. More attention should be paid to hidden blood loss and its factors during the perioperative period.