Abstract
Aim: To compare the acute haemoglobin level drop following hip fracture fixation with IMHS and CHS at James Cook University Hospital and assess whether the surgeon’s seniority has any effect on the amount of blood loss in these two procedures.
Methods: Trauma data base was searched for all IMHS procedures performed from January 2002 till March 2007 both included and CHS procedures performed from January 2007 till March 2008 both included.
There were 159 CHS procedures and 146 IMHS procedures. 137 CHS and 123 IMHS procedures fulfilled the blood testing and transfusion criteria.
Haemoglobin levels were used as an indication for blood loss attributable to surgery. The difference between the last level of haemoglobin checked preoperatively and the first post operative level performed between 12–48 hours postoperatively is calculated. Cases where blood transfusion was carried out preoperatively without further preoperative haemoglobin check were excluded, so were cases receiving intra or post operative blood transfusion prior to the defined postoperative haemoglobin check was carried out.
Results: SPSS 13.0 statistical package was used to analyse the results. Levene’s test proved equality of variances of blood loss within the two groups of patients undergoing one of the two procedures, P=0.5. Hence, Independent Samples T test was applicable and showed that patients undergoing an IMHS procedure dropped their haemoglobin levels by 2.96 g/dl. While, those undergoing a CHS procedure dropped their haemoglobin levels by 2.32 g/dl. The 0.64 g/dl difference in haemoglobin drop was statistically significant at 5% significance level with 95% CI (0.27 to 1.01), P=0.001.
The surgeons’ grades were classified into three groups as: Consultants, Registrars and Senior House Officers. Levene’s test again proved the variances of haemoglobin drop within each group to be homogeneous. Hence a One-Way ANOVA test was carried out showing that the differences in haemoglobin drop were not statistically significant when comparing the three groups of surgeons to each other. This was true for both IMHS and CHS procedures.
Conclusion: Patients undergoing a CHS procedure drop their haemoglobin levels by 0.64 g/dl less than those undergoing an IMHS procedure. The surgeon’s seniority does not make difference to the amount of haemoglobin level drop following either of the two procedures.
We recommend the use of CHS for stable fractures and reserve the IMHS for the unstable ones due to the increased blood loss with IMHS procedures.
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