TRANSFUSIONAL RISK FACTORS IN SUBCAPITAL FRACTURES OF THE HIP FOR PATIENTS OVER 65

Abstract

Introduction and Objectives: This study examines the need for transfusion in trauma surgery for subcapital fractures of the femur (SFF) in a tertiary hospital and analyzes possible predictive factors.

Materials and Methods: A prospective study was done using patients requiring surgical treatment for SFF in the year 1998. Patients younger than 65 years, those with hemopathies, and patients undergoing anticoagulant therapy were excluded from the study. The following variables were analysed: age, sex, haemogram at time of admission (haemoglobin [Hb], haematocrit [Hct], mean corpuscular volume [MCV], mean corpuscular haemoglobin [MCH], anisocytosis [area under the curve or AUC]; preoperative and postoperative Hb and Hct (preoperative values only if surgery did not take place within 48 hours of admission); time to surgical intervention, transfusions, and use of blood derivatives.

Results: The study included 75 patients operated on for SFF. These included 18 with B1 fractures, 8 with B2, and 49 with B3 based on AO classification. There were 12 males and 63 females, and average age was 81 years (standard deviation [SD]=8). Average values upon admission were as follows: Hb 128 (SD=23) g/l, Hct 39% (SD=6%), MCH 30.3 pg, MCV 91.4 fL, and AUC 14.3%. Average time to surgical intervention was 5 days (SD=2.8). Types of surgical intervention included 23 screws (31%) and 52 partial hip prostheses (69%). Preoperative average haemogram values were Hb 119 (SD=12) g/l and Hct 36% (SD=4%). Forty-one patients (55%) received transfusions of concentrated red cells. Of these, 8 (11%) were preoperative, 8 (11%) were perioperative, and 31 (41%) were in the immediate postoperative period. Gender, age, MCV, MCH, and time to surgery were not found to be related to the need for transfusion. On the other hand, correlations were found between Hb at time of admission, postoperative Hb, anisocytosis, type of fracture, and type of surgical intervention. The only variable independently-related to the need for transfusion was Hb at time of admission.

Discussion and Conclusions: In spite of the urgent nature of these cases, the results of this study suggest a need for further studies designed to improve the haematologic parameters for these elderly patients upon admission, such as the adoption of less aggressive measures and the establishment of a blood storage system for high-risk patients, with the aim of reducing the need for transfusions and the inherent risks of allogeneic blood transfusions.