Abstract
Background: To determine patients clinical and haematological characteristics that could affect the use of blood and infection incidence with hip fractures (HF) treated with a dynamic hip screw (DHS).
Patients and Methods: A retrospective study of all the HF patients during 5 years (January1995- December1999) who were treated with a dynamic hip screw (DHS ïf’, Synthes-Stratec, Oberdof, Switzerland) at one unique university hospital. No patient was excluded. Age, gender, elapsed time, anaesthesia risk (ASA clasification), type of HF (internationalAO classification), transfusion procedure and the total used; haemoglobin (Hb) at days 0 (incoming to urgency service) and first postoperative (POD ï€1) were examined. We also analyzed the infection incidence (CDC criteria), place and severity. The statistical univariate analysis included Student’s t-test for numeric variables and Pearson’s chi-squared test for string variables. There was considered to be a statistically significant difference (SSD) when p< 0.05. A multivariate stepwise logistic regression model was used.
Results: Three hundred and one patients with HF were studied. 125 A1 and 176 A2, according to the AO classification. Male/female ratio: 76/225 (25.2%/74.8%); age 78.97 years old (range: 23–104); ASA: I 53 (17.6%); II 97 (32.2%); III 138 (45.8%) and IV 13 (4.3%). Hb Values on the day of admission: 128.7 g/L (range: 81.7–176.7) and POD ï€1: 101 g/L (range: 54.7–150.7). 186 (61.8%) patients were transfused with an average 1.42 red cell concentrate (range: 0–6). 89 (29.6%) had an infection diagnosis: 79 (26.2%) urinary tract infection (UTI), 7 (2.3%) pneumonia and 8 (2.7%) superficial wound. 18 (6%) died in the first month.
At univariant study of transfusion act, the transfused patients were older (p< 0.001), suffered more infections (p:0.019), more UTI (p:0.003), had lower Hb day 0 (p< 0.001) and POD ï€1(p< 0.001). When analyze the infection, the patients were older (p< 0.001), had higher ASA (p:0.019), lower Hb at day0 (p< 0.026), longer stay (p< 0.001), were more transfused (p:0.019), and received more transfusions (p:0.004). The logistic regression analysis identified only the type of HF, the age and the Hb level (p< 0.05) as independent predictors of transfusion.
Comments: In patients with HF the Hb is the most important predictor of blood transfusion, and it is associated with a higher rate of post surgical infection and longer hospital stays. These complications may be explained by the possible inmunomodulation effect of allogenic blood transfusion.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
