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Wadhwa H, Rohde M, Oquendo Y, Chen MJ, Tigchelaar SS, Bellino M, Bishop J, Gardner MJ. Interaction of preoperative chemoprophylaxis and tranexamic acid use does not affect transfusion in acetabular fracture surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1025-1029. [PMID: 37865628 DOI: 10.1007/s00590-023-03763-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE While the effects of tranexamic acid (TXA) use on transfusion rates after acetabular fracture surgery are unclear, previous evidence suggests that holding deep vein thrombosis (DVT) chemoprophylaxis may improve TXA efficacy. This study examines whether holding DVT chemoprophylaxis in patients receiving TXA affects intraoperative and postoperative transfusion rates in acetabular fracture surgery. METHODS We reviewed electronic medical records (EMR) of 305 patients who underwent open reduction and internal fixation of acetabular fractures (AO/OTA 62) and stratified patients per the following perioperative treatment: (1) no intraoperative TXA (noTXA), (2) intraoperative TXA and no preoperative DVT prophylaxis (opTXA/noDVTP), or (3) intraoperative TXA and preoperative DVT prophylaxis (opTXA/opDVTP). The primary outcomes were need for intraoperative or postoperative transfusion. Risk factors for each primary outcome were assessed using multivariable regression. RESULTS Intraoperative or postoperative transfusion rates did not significantly differ between opTXA/opDVTP and opTXA/noDVTP groups (46.2% vs. 36%, p = 0.463; 15.4% vs. 28%, p = 0.181). Median units transfused did not differ between groups (2 ± 1 vs. 2 ± 1, p = 0.515; 2 ± 1 vs. 2 ± 0, p = 0.099). There was no association between preoperative DVT chemoprophylaxis and TXA with intraoperative or postoperative transfusions. EBL, preoperative hematocrit, and IV fluids were associated with intraoperative transfusions; age and Charlson Comorbidity Index (CCI) were associated with postoperative transfusions. CONCLUSION Our findings suggest holding DVT prophylaxis did not alter the effect of TXA on blood loss or need for transfusion.
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Affiliation(s)
- Harsh Wadhwa
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Matthew Rohde
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA.
| | - Yousi Oquendo
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Michael J Chen
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Seth S Tigchelaar
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Michael Bellino
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Julius Bishop
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
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Solarino G, Vicenti G, Bizzoca D, Zaccari D, Ginestra W, Ferorelli D, D’aprile M, Moretti B. Perioperative Blood Management Programme in Jehovah’s Witnesses Undergoing Total Hip Arthroplasty. PROSTHESIS 2023; 5:1011-1019. [DOI: 10.3390/prosthesis5040070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Total hip arthroplasties aim to improve quality of life and reduce pain in patients suffering from late-stage hip osteoarthritis. On the other hand, it may represent a risky surgical procedure in people who refuse blood products because of religious beliefs, such as Jehovah’s Witnesses (JW). Preoperative optimisation protocols of these patients allow medical professionals to perform arthroplasties in a safer manner, avoiding allogeneic blood transfusion. In our retrospective study, two groups of patients were evaluated. Group 1 included JW patients who underwent a preoperative Hb optimisation program; Group 2 included non-JW patients authorizing transfusion in case of necessity. Differences in Hb levels were as follows: before surgery (JW 14.24 ± 1.10 vs. non-JW 12.48 ± 1.00, p-value ≤ 0.05), and after surgery (day 1 Hb: JW 12.88 ± 0.90 vs. non-JW 10.04 ± 1.30, p-value ≤ 0.05; day 3 Hb: JW 14.65 ± 0.80 vs. non-JW 9.10 ± 0.90 p-value ≤ 0.05). Moreover, cost-effectiveness strategies were evaluated in both groups. Our findings support that patient blood management programs are a safe and good strategy in hip prosthetic surgery, decreasing risks and transfusion overuse.
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Affiliation(s)
- Giuseppe Solarino
- Orthopaedics Unit, Department DiBRaiN, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Giovanni Vicenti
- Orthopaedics Unit, Department DiBRaiN, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Davide Bizzoca
- Orthopaedics Unit, Department DiBRaiN, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Domenico Zaccari
- Orthopaedics Unit, Department DiBRaiN, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Walter Ginestra
- Orthopaedics Unit, Department DiBRaiN, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Davide Ferorelli
- Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Matteo D’aprile
- Orthopaedics Unit, Department DiBRaiN, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Biagio Moretti
- Orthopaedics Unit, Department DiBRaiN, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy
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Vicenti G, Solarino G, Zaccari D, Bizzoca D, Delmedico M, Carrozzo M, Ottaviani G, Simone F, Zavattini G, Moretti B. Perioperative blood management programme in Jehovah’s witnesses undergoing total knee arthroplasty: clinical results and cost-benefit analysis. Orthop Rev (Pavia) 2023; 14. [DOI: 10.52965/001c.87746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Introduction Total knee arthroplasties have the purpose to improve quality of life from joint-related pain. On the other hand, it may represent a risky surgical procedure in people who refuse blood products due to their religious beliefs, such as Jehovah’s Witnesses (JW). Preoperative optimization protocols of these patients allow performing arthroplasties in a safer manner avoiding allogeneic blood transfusion. Methods In our retrospective study, 2 groups of patients were evaluated. Group 1, included JW patients who underwent a preoperative Hb optimisation programme; group 2 included non-JW patients authorizing transfusion in case of necessity. Results Differences in Hb levels were: before surgery (JW 13,63±1,26 vs. non-JW 12,83±1,21, p-value=0,22), after surgery (day 1 Hb: JW 12,26±1,47 vs. non-JW 10,88±1,87, p-value=0,1; day 3 Hb: JW 10±2,97 vs. non-JW 9,23±1,07 p-value=0,64). In the JW group the mean Hb concentration decreased from 13,63±1,26 g/dL preoperatively to 12,26±1,47 g/dL (day 1) while in non-JW group fell from 12,83± g/dL to 10,88± g/dL. There was no statistically-difference between the 2 groups. Moreover, cost-effectiveness strategies were evaluated in both groups. Conclusion Our findings support that PBM programs represent a safe and good strategy in knee prosthetic surgery, decreasing costs, risks and transfusion overuse.
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Kenmegne GR, Zou C, Lin Y, Yin Y, Huang S, Banneyake EL, Gunasekera IS, Fang Y. A prophylactic TXA administration effectively reduces the risk of intraoperative bleeding during open management of pelvic and acetabular fractures. Sci Rep 2023; 13:12570. [PMID: 37532829 PMCID: PMC10397234 DOI: 10.1038/s41598-023-39873-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/01/2023] [Indexed: 08/04/2023] Open
Abstract
This study aimed to evaluate the efficacy of perioperative intravenous TXA in reducing blood loss in pelvic and acetabular fracture patients managed surgically. The study included 306 consecutive patients, divided as: group I, 157 patients who did not receive perioperative infusion of TXA and group II, 149 patients who received perioperative TXA. The perioperative blood test results and complication rates were compared between the two groups. The average perioperative hematocrit was higher during the preoperative period than during the first, second and third postoperative day in both groups. In the estimated blood loss between the two groups, there was a significant difference of 1391 (± 167.49) ml in group I and 725 (± 403.31) ml in group II respectively (p = 0.02). No significant difference was seen in the total of intraoperative transfusion units as well as in the total units of blood transfused. There was a reduced level of postoperative hemoglobin (9.28 ± 17.88 g/dl in group I and 10.06 ± 27.57 g/dl in group II compared to the values obtained in preoperative investigations (10.4 ± 2.37 g/dl in group I and 11.4 ± 2.08 g/dl in group II); with a significant difference in postoperative transfusion rates (p = 0.03). Therefore, the use of TXA effectively reduces the risk of intraoperative bleeding during open management of pelvic and acetabular fractures.
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Affiliation(s)
- Guy Romeo Kenmegne
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chang Zou
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yixiang Lin
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yijie Yin
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Shenbo Huang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Erandathie Lasanda Banneyake
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Imani Savishka Gunasekera
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yue Fang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China.
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Chowdhury D. To Assess the Outcomes Associated With the Use of Tranexamic Acid in the Open Fixation of Pelvic and Acetabular Fractures. Cureus 2023; 15:e38232. [PMID: 37261178 PMCID: PMC10226826 DOI: 10.7759/cureus.38232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
There is a growing knowledge base for the use of antifibrinolytic therapy in trauma and orthopaedic surgery. The mechanism of action of tranexamic acid (TXA) is through the inhibition of fibrinolysis. The role of TXA in hip fractures has been researched extensively. However, the research has been limited to the cases of pelvic and acetabular fractures. This systematic review aimed to examine the effect of TXA on patients undergoing open pelvic and acetabular fracture surgery. The primary goal of the study was to examine the estimated blood loss (EBL) and blood transfusion rates in patients who received TXA versus those who did not receive TXA. The secondary goal was to examine the rates of deep venous thrombosis (DVT). A literature search was carried out using PubMed, Medline and the Cochrane database. The selection criteria for the systematic review were studies investigating intravenous TXA in the form of randomised controlled trials (RCTs), as well as cohort studies. Five studies were included in the systematic review with 625 total patients. The EBL between the two groups was noted to be 661 mL in the control group and 850 mL in the TXA (p=0.49). There was a marginally lower number of units transfused in the control group vs the TXA group (1.9 vs 2.2) (p=0.27). The rates of transfusion in the TXA group were 29% TXA whilst, in the control group, it was 31% (p=0.13). The overall incidence of DVT was 2.8% in the TXA group and 1.7% in the control group (p=0.097).
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Affiliation(s)
- Debkumar Chowdhury
- Department of Emergency Medicine, Manchester Royal Infirmary, Manchester, GBR
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Ongzalima C, Dasborough K, Narula S, Boardman G, Kumarasinghe P, Seymour H. Perioperative Management and Outcomes of Hip Fracture Patients with Advanced Chronic Kidney Disease. Geriatr Orthop Surg Rehabil 2022; 13:21514593221138658. [PMID: 36420088 PMCID: PMC9677301 DOI: 10.1177/21514593221138658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/25/2022] [Indexed: 09/08/2024] Open
Abstract
Aims To explore clinical characteristics, perioperative management and outcomes of Hip Fracture patients with advanced Chronic Kidney Disease (HF-aCKD) compared to the general Hip Fracture population without aCKD (HF-G) within a large volume tertiary hospital in Western Australia. Methods Retrospective chart review of patients admitted with hip fracture (HF) to a single large volume tertiary hospital registered on Australian and New Zealand Hip Fracture Registry (ANZHFR). We compared baseline demographic and clinical frailty scale (CFS) of HF-aCKD (n = 74), defined as eGFR < 30 mls/min/1.73 m2, with HF-G (n = 452) and determined their outcomes at 120 days. Results We identified 74 (6.97%) HF patients with aCKD. General demographics were similar in HF-aCKD and HF-G populations. 120-days mortality for HF-aCKD was double that of HF-G population (34% vs 17%, P = .001). For dialysis patients, 120-days mortality was triple that of HF-G population (57%). Except for the fit category of HF-aCKD group, higher CFS was associated with higher 120-days mortality in both groups. Of all HF-aCKD patients, 96% had operative intervention and 48% received blood transfusion. There were no new starts to dialysis peri-operatively. Each point reduction in eGFR below 12 mL/min/1.73 m2 was associated with 3% increased probability of death in hospital. Conclusions 120-days mortality was double in HF-aCKD and triple in HF-dialysis that of the HF-G within our institution. Clinical frailty scale can be useful in predicting mortality after HF in frail aCKD patients. High rate of blood transfusions was observed in HF-aCKD group. Further studies with larger HF-aCKD numbers are required to explore these associations in detail.
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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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Kim MS, Koh IJ, Sung YG, Park DC, Ha WJ, In Y. Intravenous Tranexamic Acid Has Benefit for Reducing Blood Loss after Open-Wedge High Tibial Osteotomy: A Randomized Controlled Trial. J Clin Med 2021; 10:3272. [PMID: 34362054 PMCID: PMC8347076 DOI: 10.3390/jcm10153272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
(1) Background: the purpose of this study was to investigate the efficacy and safety of intravenous (IV) administration of tranexamic acid (TXA) in patients undergoing medial opening wedge high tibial osteotomy (MOWHTO). (2) Methods: a total of 73 patients were randomly allocated into two groups (TXA group and control group). The primary outcome was total perioperative calculated blood loss after MOWHTO. Secondary outcomes included self-reported pain severity using a 10-point visual analog scale (VAS) and the EuroQol-5 Dimension (EQ-5D) questionnaire. The postoperative allogeneic transfusion rate and wound complications were compared. Deep vein thrombosis (DVT) incidence was compared by conducting DVT computed tomography imaging. (3) Results: the total blood loss after surgery was 470.9 mL in the TXA group and 739.3 mL in the control group, showing a significant difference (p < 0.001). There were no differences in pain VAS scores between the two groups (all p > 0.05). No difference in preoperative EQ-5D scores for any items existed between the two groups. No transfusion was performed in either group. There was no difference in DVT incidence or the rate of wound complications between the two groups. (4) Conclusion: in patients undergoing MOWHTO, IV TXA reduces total blood loss and drainage amount. However, no additional benefits in clinical outcomes, transfusion rate, or wound complications were apparent, with similar DVT incidence rates.
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Affiliation(s)
- Man-Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (M.-S.K.); (Y.-G.S.); (D.-C.P.); (W.-J.H.)
| | - In-Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul 03312, Korea;
| | - Yong-Gyu Sung
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (M.-S.K.); (Y.-G.S.); (D.-C.P.); (W.-J.H.)
| | - Dong-Chul Park
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (M.-S.K.); (Y.-G.S.); (D.-C.P.); (W.-J.H.)
| | - Won-Jun Ha
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (M.-S.K.); (Y.-G.S.); (D.-C.P.); (W.-J.H.)
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (M.-S.K.); (Y.-G.S.); (D.-C.P.); (W.-J.H.)
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Amin RM, Puvanesarajah V, Chaudhry YP, Best MJ, Rao SS, Frank SM, Hasenboehler EA. Reducing unnecessary crossmatching for hip fracture patients by accounting for preoperative hemoglobin concentration. World J Orthop 2021; 12:292-300. [PMID: 34055586 PMCID: PMC8152439 DOI: 10.5312/wjo.v12.i5.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/18/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources. Most protocols recommend type and cross of 2 red blood cell (RBC) units for patients undergoing surgery for treatment of hip fracture. Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion, but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.
AIM To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion (C:T) ratio in hip fracture surgery patients.
METHODS In 2015 a patient blood management (PBM) program was implemented at our institution mandating a single unit-per-occurrence transfusion policy and a restrictive transfusion threshold of < 7 g/dL hemoglobin in asymptomatic patients and < 8 g/dL in those with refractory symptomatic anemia or history of coronary artery disease. We identified all hip fracture patients between 2013 and 2017 and compared the preoperative hemoglobin which would predict a 2:1 C:T ratio in the pre PBM and post PBM cohorts. Prediction profiling and sensitivity analysis were performed with statistical significance set at P < 0.05.
RESULTS Four hundred and ninety-eight patients who underwent hip fracture surgery between 2013 and 2017 were identified, 291 in the post PBM cohort. Transfusion requirements in the post PBM cohort were lower (51% vs 33%, P < 0.0001) than in the pre PBM cohort. The mean RBC units transfused per patient was 1.15 in the pre PBM cohort, compared to 0.66 in the post PBM cohort (P < 0.001). The 2:1 C:T ratio (inpatient transfusion probability of 50%) was predicted by a preoperative hemoglobin of 12.3 g/dL [area under the curve (AUC) 0.78 (95% confidence interval (CI), 0.72-0.83), Sensitivity 0.66] in the pre PBM cohort and 10.7 g/dL [AUC 0.78 (95%CI, 0.73-0.83), Sensitivity 0.88] in the post PBM cohort. A 50% probability of requiring > 1 RBC unit was predicted by 11.2g/dL [AUC 0.80 (95%CI, 0.74-0.85), Sensitivity 0.87] in the pre PBM cohort and 8.7g/dL [AUC 0.78 (95%CI, 0.73-0.83), Sensitivity 0.84] in the post-PBM cohort.
CONCLUSION The hip fracture maximum surgical blood order schedule should consider preoperative hemoglobin in determining the number of units to type and cross prior to surgery.
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Affiliation(s)
- Raj M Amin
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA 94305, United States
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
| | - Yash P Chaudhry
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19122, United States
| | - Matthew J Best
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MD 02114, United States
| | - Sandesh S Rao
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
| | - Steven M Frank
- Department of Anesthesiology, Critical Care Medicine, Baltimore, MD 21205, United States
| | - Erik A Hasenboehler
- Department of Orthopaedics, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
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Efficacy and Safety of Intravenous Ferric Carboxymaltose in Patients with Postoperative Anemia Following Same-Day Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial. J Clin Med 2021; 10:jcm10071457. [PMID: 33918110 PMCID: PMC8036569 DOI: 10.3390/jcm10071457] [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] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 01/28/2023] Open
Abstract
(1) Background: The purpose of this study was to evaluate the efficacy and safety of intravenous (IV) ferric carboxymaltose (FCM) to treat acute postoperative anemia following same-day bilateral total knee arthroplasty (TKA). (2) Methods: A total of 118 patients who underwent same-day bilateral TKA were randomly assigned to two groups: an FCM group (FCM infusion, 58 patients) and a Control group (placebo with normal saline, 60 patients). The primary endpoint was the number of responders with a Hb increase of two or more points by the second postoperative week. The secondary endpoints were Hb level, iron metabolism variables and blood transfusion rate at 2, 6 and 12 weeks after surgery. (3) Results: The FCM group had more Hb responders than the Control group (62.1% vs. 31.6%, p < 0.001). The Hb level was significantly higher in the FCM group during 12 weeks after surgery (all p < 0.05). Ferritin, iron and transferrin saturation levels were significantly higher in the FCM group from 2 to 12 weeks postoperatively (all p < 0.05). There was no difference in transfusion rate after surgery (p > 0.05). (4) Conclusion: In patients with postoperative anemia after same-day bilateral TKA, IV FCM infusion significantly improved Hb response two weeks after surgery without severe adverse events compared to placebo. In contrast, transfusion rate and various parameters of quality of life assessment up to 12 weeks did not vary between these groups. Level of evidence: Level I.
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Viberg B, Gundtoft PH, Schønnemann JO, Pedersen L, Andersen LR, Titlestad K, Madsen CF, Clemmensen SB, Halekoh U, Lauritsen J, Overgaard S. Is tranexamic acid use in patients with a hip fracture safe? Bone Joint J 2021; 103-B:449-455. [PMID: 33641426 DOI: 10.1302/0301-620x.103b3.bjj-2020-1375.r2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIMS To assess the safety of tranexamic acid (TXA) in a large cohort of patients aged over 65 years who have sustained a hip fracture, with a focus on transfusion rates, mortality, and thromboembolic events. METHODS This is a consecutive cohort study with prospectively collected registry data. Patients with a hip fracture in the Region of Southern Denmark were included over a two-year time period (2015 to 2017) with the first year constituting a control group. In the second year, perioperative TXA was introduced as an intervention. Outcome was transfusion frequency, 30-day and 90-day mortality, and thromboembolic events. The latter was defined as any diagnosis or death due to arterial or venous thrombosis. The results are presented as relative risk (RR) and hazard ratio (HR) with 95% confidence intervals (CIs). RESULTS A total of 3,097 patients were included: 1,558 in the control group and 1,539 in the TXA group.31% (n = 477) of patients had transfusions in the control group compared to 27% (n = 405) in the TXA group yielding an adjusted RR of 0.83 (95% CI 0.75 to 0.91). TXA was not associated with increased 30-day mortality with an adjusted HR of 1.10 (95% CI 0.88 to 1.39) compared to the control group as well as no association with increased risk of 90-day mortality with a per protocol adjusted HR of 1.24 (95% CI 0.93 to 1.66). TXA was associated with a lower risk of thromboembolic events after 30 days (RR 0.63 (95% CI 0.42 to 0.93)) and 90 days (RR 0.72 (95% CI 0.52 to 0.99)). A subanalysis on haemoglobin demonstrated a median 17.7 g/L (interquartile range (IQR) 11.3 to 27.3) decrease in the control group compared to 17.7 g/L (IQR 9.7 to 25.8) in the per protocol TXA group (p = 0.060 on group level difference). CONCLUSION TXA use in patients with a hip fracture, was not associated with an increased risk of mortality but was associated with lower transfusion rate and reduced thromboembolic events. Thus, we conclude that it is safe to use TXA in this patient group. Cite this article: Bone Joint J 2021;103-B(3):449-455.
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Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Kolding, Denmark
| | - Per Hviid Gundtoft
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Kolding, Denmark
| | | | - Lasse Pedersen
- Department of Orthopaedic Surgery and Traumatology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Lis Røhl Andersen
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - part of Hospital Lillebaelt, Kolding, Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Carsten Fladmose Madsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Signe Bedsted Clemmensen
- Department of Public Health, EBB - Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Ulrich Halekoh
- Department of Public Health, EBB - Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Jens Lauritsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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12
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Cohen-Levy WB, Rush AJ, Goldstein JP, Sheu JI, Hernandez-Irizarry RC, Quinnan SM. Tranexamic acid with a pre-operative suspension of anticoagulation decreases operative time and blood transfusion in the treatment of pelvic and acetabulum fractures. INTERNATIONAL ORTHOPAEDICS 2020; 44:1815-1822. [DOI: 10.1007/s00264-020-04595-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/27/2020] [Indexed: 12/18/2022]
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13
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Shander A, Zacharowski K, Spahn DR. Red cell use in trauma. Curr Opin Anaesthesiol 2020; 33:220-226. [PMID: 32004168 DOI: 10.1097/aco.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Red cell transfusions are commonly used in management of hemorrhage in trauma patients. The appropriate indications and criteria for transfusion are still debated. Here, we summarize the recent findings on the use of red cell transfusion in trauma setting. RECENT FINDINGS Recent evidence continues to support the long-established link between allogeneic transfusion and worse clinical outcomes, reinstating the importance of more judicious use of allogeneic blood and careful consideration of benefits versus risks when making transfusion decisions. Studies support restrictive transfusion strategies (often based on hemoglobin thresholds of 7-8 g/dl) in most patient populations, although some argue more caution in specific populations (e.g. patients with traumatic brain injury) and more studies are needed to determine if these patients benefit from less restrictive transfusion strategies. It should be remembered that anemia remains an independent risk factor for worse outcomes and red cell transfusion does not constitute a lasting treatment. Anemia should be properly assessed and managed based on the cause and using hematinic medications as indicated. SUMMARY Although the debate on hemoglobin thresholds for transfusion continues, clinicians should not overlook proper management of the underlying issue (anemia).
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Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology and Critical Care Medicine; Englewood Hospital and Medical Center.,TeamHealth Research Institute; Englewood.,Icahn School Of Medicine at Mount Sinai, New York, NY, USA
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Main, Germany
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital Zürich, Zürich, Switzerland
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14
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Bolz NJ, Zarling BJ, Markel DC. Long-Term Sustainability of a Quality Initiative Program on Transfusion Rates in Total Joint Arthroplasty: A Follow-Up Study. J Arthroplasty 2020; 35:340-346. [PMID: 31548114 DOI: 10.1016/j.arth.2019.08.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/16/2019] [Accepted: 08/27/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are significant variations in transfusion rates among institutions performing total joint arthroplasty. We previously demonstrated that implementation of an educational program to increase awareness of the American Association of Blood Banks' transfusion guidelines led to an immediate decrease in transfusion rates at our facilities. It remained unclear how this initiative would endure over time. We report the long-term success and sustainability of this quality program. METHODS We reviewed the Michigan Arthroplasty Collaborative Quality Initiative data from 2012 through 2017 of all patients undergoing primary hip and knee arthroplasty at our institutions for preoperative and postoperative hemoglobin level, transfusion status, and number of units transfused and transfusions outside of protocol to identify changes surrounding our blood transfusion educational initiative. We calculated the transfusions prevented and cost implications over the course of the study. RESULTS We identified 6645 primary hip and knee arthroplasty patients. There was a significant decrease in transfusion rate and overall transfusions in each group when compared to pre-education values. Subgroup analysis of TKA and THA independently showed significant decreases in both transfusion rate and overall transfusions. Over the final 3 years of the study, only 2 patients were transfused outside of the American Association of Blood Banks protocol. We estimate prevention of 519 transfusions over the study period. CONCLUSION Application of this quality initiative was an effective means of identifying opportunities for quality improvement. The program was easily initiated, had significant early impact, and has been shown to be sustainable.
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Affiliation(s)
- Nicholas J Bolz
- Section of Orthopaedic Surgery, Ascension Providence Hospital, Novi, MI; Detroit Medical Center/Wayne State University Orthopedic Residency Program, Detroit, MI
| | - Bradley J Zarling
- Section of Orthopaedic Surgery, Ascension Providence Hospital, Novi, MI; Detroit Medical Center/Wayne State University Orthopedic Residency Program, Detroit, MI
| | - David C Markel
- Section of Orthopaedic Surgery, Ascension Providence Hospital, Novi, MI; Detroit Medical Center/Wayne State University Orthopedic Residency Program, Detroit, MI; The Core Institute, Novi, MI
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15
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Kristensen PK, Röck ND, Christensen HC, Pedersen AB. The Danish Multidisciplinary Hip Fracture Registry 13-Year Results from a Population-Based Cohort of Hip Fracture Patients. Clin Epidemiol 2020; 12:9-21. [PMID: 32021467 PMCID: PMC6959215 DOI: 10.2147/clep.s231578] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022] Open
Abstract
AIM OF THE REGISTRY The aim of the Danish Multidisciplinary Hip Fracture Registry (DMHFR) is to collect data on processes of treatment, nursing care and rehabilitation as well as outcomes for patients with hip fracture in Denmark, and thereby monitor and improve the quality. STUDY POPULATION Hip fracture patients at age 65 or older that have undergone surgery with arthroplasty or internal fixation since 2004. MAIN VARIABLES DMHFR collects quality indicators and descriptive variables. Quality indicators include eight process performance measures within treatment, nursing care and rehabilitation, reflecting recommendations from the national clinical guideline for hip fracture patients, and three outcome measures including survival within 30-days, unplanned acute readmission within 30 days and reoperation within 2 years. Descriptive variables include a number of patient- and surgery-related characteristics. All data are collected prospectively. RESULTS By the end of 2018, the DMHFR included 86,438 hip fracture patients. Since 2006, all hospital departments in Denmark, treating patients with hip fracture, have reported improvement in quality of care and improvement in survival, and reoperation over time as well as high completeness of variables registration. CONCLUSION The DMHFR is a well-established nationwide clinical registry, which plays a key role for monitoring and improving hip fracture care in Denmark. The registry can further be linked to a range of other nationwide registries in order to answer a number of relevant clinical research questions.
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Affiliation(s)
- Pia Kjær Kristensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Niels Dieter Röck
- Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark
| | - Helle Collatz Christensen
- Danish Clinical Quality Program (RKKP) National Clinical Registries, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Alma Becic Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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16
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Geneviève LD, Martani A, Mallet MC, Wangmo T, Elger BS. Factors influencing harmonized health data collection, sharing and linkage in Denmark and Switzerland: A systematic review. PLoS One 2019; 14:e0226015. [PMID: 31830124 PMCID: PMC6907832 DOI: 10.1371/journal.pone.0226015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The digitalization of medicine has led to a considerable growth of heterogeneous health datasets, which could improve healthcare research if integrated into the clinical life cycle. This process requires, amongst other things, the harmonization of these datasets, which is a prerequisite to improve their quality, re-usability and interoperability. However, there is a wide range of factors that either hinder or favor the harmonized collection, sharing and linkage of health data. OBJECTIVE This systematic review aims to identify barriers and facilitators to health data harmonization-including data sharing and linkage-by a comparative analysis of studies from Denmark and Switzerland. METHODS Publications from PubMed, Web of Science, EMBASE and CINAHL involving cross-institutional or cross-border collection, sharing or linkage of health data from Denmark or Switzerland were searched to identify the reported barriers and facilitators to data harmonization. RESULTS Of the 345 projects included, 240 were single-country and 105 were multinational studies. Regarding national projects, a Swiss study reported on average more barriers and facilitators than a Danish study. Barriers and facilitators of a technical nature were most frequently reported. CONCLUSION This systematic review gathered evidence from Denmark and Switzerland on barriers and facilitators concerning data harmonization, sharing and linkage. Barriers and facilitators were strictly interrelated with the national context where projects were carried out. Structural changes, such as legislation implemented at the national level, were mirrored in the projects. This underlines the impact of national strategies in the field of health data. Our findings also suggest that more openness and clarity in the reporting of both barriers and facilitators to data harmonization constitute a key element to promote the successful management of new projects using health data and the implementation of proper policies in this field. Our study findings are thus meaningful beyond these two countries.
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Affiliation(s)
| | - Andrea Martani
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | | | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice Simone Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- University Center of Legal Medicine, University of Geneva, Geneva, Switzerland
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17
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Yu X, Wang Z, Wang Y, Huang Y, Xin S, Sun H, Zhang X, Wang Y, Han W, Xue F, Wang L, Hu Y, Xu M, Li L, He J, Jiang J. Cost-effectiveness comparison of routine transfusion with restrictive and liberal transfusion strategies for surgical patients in China. Vox Sang 2019; 114:721-739. [PMID: 31373018 DOI: 10.1111/vox.12817] [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: 01/10/2019] [Revised: 04/13/2019] [Accepted: 05/22/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES A health industry standard recommending restrictive transfusion is to be in effect in China in April 2019. We aim to explore its potential economic and clinical impacts among surgical patients. MATERIALS AND METHODS A decision tree model was applied to compare cost-effectiveness of current routine transfusion in China, a restrictive (transfusion at Hb < 8 g/dl or ischaemic symptoms) and a liberal (transfusion at Hb < 10 g/dl) strategy. Parameters were estimated from empirical data of 25 227 surgical inpatients aged ≥30 years in a multicenter study and supplemented by meta-analysis when necessary. Results are shown for cardio-cerebral-vascular (CCV) surgery and non-CCV (orthopaedics, general, thoracic) surgery separately. RESULTS Per 10 000 patients in routine, restrictive, liberal transfusion scenarios, total spending (transfusion and length of stay related) was 7·67, 7·58 and 9·39 million CNY (1 CNY × 0.157 = 1 US dollar) for CCV surgery and 6·35, 6·70 and 8·09 million CNY for non-CCV surgery; infectious and severe complications numbered 354, 290, and 290 (CCV) and 315, 286, and 330 (non-CCV), respectively. Acceptability curves showed high probabilities for restrictive strategy to be cost-effective across a wide range of willingness-to-pay values. Such findings were mostly consistent in sensitivity and subgroup analyses except for patients with cardiac problems. CONCLUSION We showed strong rationale, succeeding previous findings only in cardiac or joint procedures, to comply with the new standard as restrictive transfusion has high potential to save blood, secure safety, and is cost-effective for a wide spectrum of surgical patients. Experiences should be further summarized to pave the way towards individualized transfusion.
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Affiliation(s)
- Xiaochu Yu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zixing Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yipeng Wang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuguang Huang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shijie Xin
- First Hospital of China Medical University, Shenyang, China
| | - Hong Sun
- Xiangya Hospital, Central South University, Changsha, China
| | - Xu Zhang
- First Hospital of China Medical University, Shenyang, China
| | - Yaolei Wang
- Xiangya Hospital, Central South University, Changsha, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fang Xue
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lei Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yaoda Hu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mei Xu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Li
- First Hospital of China Medical University, Shenyang, China
| | - Jiqun He
- Xiangya Hospital, Central South University, Changsha, China
| | - Jingmei Jiang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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18
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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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