Title : Predicting the drop of haemoglobin in hip fracture surgery
Abstract:
Background: Hip fractures are becoming increasingly prevalent secondary to ageing populations, with a large burden on healthcare systems globally. Hip fracture surgery is associated with significant blood loss and concomitant risk of post-operative anaemia.To date, the expected drop in haemoglobin (Hb) secondary to hip fracture surgery is yet to be determined. The aims of this study were to assess the Hb drop in patients undergoing hip fracture surgery and to identify any independent factors that influence this.
Methods: A retrospective analysis was carried out of all patients who underwent hip fracture surgery at a UK trauma unit over a 9-month period. Data collected included patient demographics, use of anticoagulants or antiplatelets, time from injury to surgery, fracture subtype, operation, operative time, and pre-and post-operative Hb. Change in Hb was analysed using the Student’s-test. Ordinary one-way ANOVA and Turkey’s multiple comparisons test were used to analyse the change in Hb between multiple variables.
Results: 415 patients were identified (mean age 81.6 years), with an average time from injury to surgery of 1.9 days. Mean pre-operative Hb was 119g/L and mean day 1 post-operative Hb was 100g/L, indicating a drop of 19g/L (16%) across all patients. There was a significant drop in Hb with hemiarthroplasty (18g/L, 14.5%), total hip arthroplasty (23g/L, 18.4%), dynamic hip screw fixation (23g/L, 19.7%) and intramedullary nail fixation (23g/L, 20.5%) (p<0.0001). A nonsignificant reduction (p=0.0585) in Hb was seen with cannulated screw fixation (9g/L, 7.3%) (p=0.0585). There was a trend towards a lower drop in Hb with shorter operative time, however this was not statistically significant (p=0.109). There was no significant difference in Hb drop if patients were on anticoagulants or antiplatelets (p=0.433).
Conclusion: Hip fracture surgery is associated with a significant drop in Hb regardless of procedure, except for cannulated screw fixation. A trend towards a lower drop in Hb is seen with shorter operative time. Anticoagulants or antiplatelets are not independent risk factors for increased peri-operative blood loss. This study provides an average drop in Hb that can be expected with hip fracture surgery and therefore aids in predicting which patients may require pre-operative transfusion to optimise recovery.
What will the audience learn from your presentation?
- Expected Haemoglobin Drop: Hip fracture surgery typically results in a significant drop in haemoglobin levels, with an average decrease of 19g/L (16%) across all procedures, except for cannulated screw fixation.
- Procedure-Specific Variations: The extent of the haemoglobin drop varies by surgical procedure, being most significant in total hip arthroplasty, dynamic hip screw fixation, and intramedullary nail fixation.
- Factors Influencing Hb Drop: Shorter operative times may be associated with a smaller Hb drop, although not statistically significant. The use of anticoagulants or antiplatelets does not independently increase the risk of peri-operative blood loss.
