Abstract
Introduction
Despite advances in surgical and anaesthetic techniques the mortality after hip fracture
has not significantly changed in the last 40 years. Pre-operative anaemia is a risk
factor for peri-operative death.
We speculate that a significant proportion of the blood loss related to hip fractures
has occurred prior to surgery. Identifying patients at risk of pre-operative anaemia
can facilitate appropriate medical optimisation. This study is unique in its attempt
to quantify the blood loss associated with the initial hip injury.
Methods
In a retrospective study all patients with both a diagnosis of hip fracture and an
operative delay of >48 h were assessed. The information collected included: fracture classification, serial
haemoglobins and patient co-morbidities. The exclusion criteria included a pre-injury
diagnosis of anaemia, anti-coagulation and gastrointestinal bleeds.
Results
Between 2007/2008 sixty-eight intracapsular and fifty extracapsular hip fracture patients
had serial haemoglobins and operative delays of >48 h (mean 75 h, range 48–270 h). The mean lowest recorded haemoglobin prior to surgery for both extracapsular and
intracapsular fractures were 95.0 g/L (±SEM 2.2) and 108.5 g/L (±SEM 2.2) respectively. This difference was statistically significant (Student's
t-test p < 0.05).
The mean haemoglobin drop in the extracapsular and intracapsular fracture groups was
20.2 g/L (range 0–49 g/L) and 14.9 g/L (range 0–59 g/L) respectively.
Conclusions
Hip fracture patients have a large drop in haemoglobin that is associated with the
initial trauma rather than the operation. This highlights the need for anaesthetic
and orthopaedic staff to be vigilant to the risk of pre-operative anaemia in this
cohort of frail patients even when the initial haemoglobin is apparently normal.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Guidelines on the management of massive blood loss.Br J Haem. 2006; 135: 634-641
- Severity of anaemia and operative mortality and morbidity.Lancet. 1988; 331: 727-729
- Preoperative characteristics identify patients with hip fractures at risk of transfusion.CORR. 2005; 439: 201-206
- Hidden blood loss after surgery for hip fracture.JBJS (Br). 2006; 88: 1053-1058
- Mortality analysis in hip fractures patients: implications for design of future outcome trials.Br J Anaesth. 2005; 94: 24-29
- Mortality following hip fracture: trends and geographical variations over the last 40 years.Injury Extra. 2008; 39: 201
- Gender differences in epidemiology and outcome after hip fracture: evidence from the Scottish Hip Fracture Audit.JBJS Br. 2008; 90: 480-483
- Pathophysiology and clinical implications of perioperative fluid excess.Br J Anaesth. 2002; 89: 622-632
- The transfusion of red cells.in: Mollison P.L. Engelfreit C.P. Contreras M. Blood transfusion in clinical medicine. 9th ed. Blackwell Scientific Publications, Oxford1993: 423
- Cross-match protocols for femoral neck fractures—finding one that can work.Ann R Coll Surg Engl. 2004; 86 (4): 11-14
- Early mortality after hip fracture: is delay before surgery important?.J Bone Joint Surg (Am). 2005; 87: 483-489
- Predictors of excessive blood loss during operative treatment of hip fractures.J R Coll Surg Edinb. 2002; 47: 552-556
- Osteoporosis. Clinical guidelines for prevention and treatment.Royal College of Physicians of London, London1999
World Health Organization. Indicators and strategies for iron deficiency and anemia programmes. Report of the WHO/UNICEF/UNU consultation. Geneva, Switzerland, 6–10 December 1993; 1994.
Article info
Publication history
Accepted:
February 11,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
