Title : Factors affecting transfusion and haemoglobin drop following IM tibial nails
Abstract:
Introduction: Our current hospital MSBOS requires 2x valid Group & Saves for IM tibial nails. There are no national or international guidelines for this operation, and there are very few published papers discussing blood loss following IM tibial nails. As this injury is high risk for compartment syndrome and we felt the risk of transfusion was low, we suspected excess unnecessary testing was causing surgical delays and cost. A retrospective cohort study was carried out to investigate the rate and risk factors for transfusion and Hb drop following IM tibial nails.
Method: Patients details were collected for all IM tibial nails in GRI between 1/1/2020 – 1/1/2025. Open fractures requiring free flap coverage and polytraumas were excluded. Open fractures which were viable for primary wound closure were included. Risk factors assessed included sex, age, BMI, fracture type, approach, ASA, pre-op Hb, tourniquet use, TXA use, coagulation screen, platelets, antiplatelet/anticoagulant use and smoking status.
Results: 189 patients met inclusion criteria from 1/1/2020 – 1/1/2025. The median age was 44 with an even spread of patients across ASA 1-3. 304 G&S were sent purely on acute admission and 34 units of packed red cells were cross-matched. Of those, 3 patients (1.59%) required transfusion post-op, all day 2 post-op, one of whom was transfusion dependent at baseline. 134 patients had pre-and post-op FBC. Average Hb drop was 23.01 ± 11.18 g/L. Open fractures showed a statistically significant increase in Hb drop (p=0.001). Pre-op anaemia showed a statistically significant decrease in post-op Hb drop (p=<0.001). This was confirmed on univariate and multivariate analyses. There were no other statistically significant correlations.
Conclusion: Open fractures were more likely to cause an increased Hb drop, whilst presence of anaemia pre-op caused a reduced Hb drop. This did not correlate to an increased risk of transfusion as all transfusions were closed fractures. With only 3 transfusions, factors contributing to transfusion requirements could not be analysed. We feel this supports the hypothesis that our local MSBOS G&S requirements for IM tibial nails should be reduced.
