Factors Affecting the Perioperative Blood Transfusion Need in Geriatric Hip Fractures

Öz

Hip fractures are an important cause of hospitalization and long hospital stays in the elderly. Allogeneic blood transfusion(ABT) affects patient health and also has economic effects.Therefore, more data on blood management are needed to improve patient outcomes, and optimize resource use. In this study,our primary aim was to determine the predictive factors affecting the need for ABT after geriatric hip fractures. A total of 596 hip fractures patients who were treated surgically in our clinic between 2011 and 2021 were analyzed. Age, gender, fracture type ,ASA score, surgical delay time, anesthesia type, surgery type, use of antiaggregants or anticoagulants, complications and hemoglobin (Hg), hematocrit (Hct), creatinine and INR levels at the time of admission were obtained. Binary logistic regression was employed to determine the risk factors. The receiver operating characteristic(ROC) curve was used to determine the appropriate cut-off point . While the mean Hg value of the patients who underwent ABT was 10.6±1.2 g/dl at the time of admission (p<0.001), the mean Hct value was 31.6±3.7%(p<0.001) and the mean creatinine was 1.25±0.88mg/dl (p=0.007). The outcomes of the regression analysis showed that the preoperative Hg level (p<0.001, OR:0.113, CI:0.068-0.190) and the preoperative Hct level (p=0.016,OR: 0.841, CI:0.730-0.968) were predictive factors for ABT. The ROC analysis showed that, a cut-off value of ≤11.9 g/dl was found for preoperative Hg and ≤35.5% for preoperative Hct. The main factors determining the need for blood transfusion are the Hg and Hct values at the time of admission. A Hg level of ≤11.9 g/dl and a Hct level of ≤35.5% can be safely used as a cut-off value.

Anahtar Kelimeler

• geriatric hip fractures
• blood transfusion
• cut-off value
• predictors

Geriatrik Kalça Kırıklarında Perioperatif Kan Transfüzyon İhtiyacına Etki Eden Faktörler

Öz

Kalça kırıkları geriatrik hastalarda hastaneye yatışların önemli bir nedenidir. Allojenik kan transfüzyonu (AKT) hasta sağlığını etkiler ve ayrıca ekonomik etkileri vardır. Bu nedenle, hasta sonuçlarını iyileştirmek ve kaynak kullanımını optimize etmek için kan yönetimi hakkında daha fazla veriye ihtiyaç vardır. Bu çalışmada birincil amacımız geriatrik kalça kırıkları sonrası AKT ihtiyacını etkileyen prediktif faktörleri belirlemekti.Yöntemler: Kliniğimizde 2011-2021 yılları arasında cerrahi olarak tedavi edilen toplam 596 kalça kırığı hastası analiz edildi. Yaş, cinsiyet, kırık tipi, ASA skoru, cerrahi gecikme süresi, anestezi tipi, ameliyat tipi, antiagregan veya antikoagülan kullanımı, komplikasyonlar ve başvuru anındaki hemoglobin (Hg), hematokrit (Hct), kreatinin ve INR değerleri belirlendi. Risk faktörlerini belirlemek için ikili lojistik regresyon kullanıldı. Uygun kesme noktasını belirlemek için ROC eğrisi kullanıldı. AKT uygulanan hastaların başvuru anında ortalama Hg değeri 10,6±1,2 g/dl iken (p<0,001), ortalama Hct değeri %31,6±3,7 (p<0,001) ve ortalama kreatinin değeri; 1,25±0,88mg/dl (p=0,007). Regresyon analizi sonuçları, preoperatif Hg seviyesinin (p<0,001, OR:0.113, CI:0.068-0.190) ve preoperatif Hct seviyesinin (p=0.016,OR:0.841, CI:0.730-0.968) AKT için prediktif faktörler olduğunu gösterdi. ROC analizi, preoperatif Hg için ≤11,9 g/dl ve preoperatif Hct için ≤35.5'lik bir cut-off değerinin bulunduğunu gösterdi. Kan transfüzyonu ihtiyacını belirleyen ana faktörler başvuru anındaki Hg ve Hct değerleridir. ≤11,9 g/dl'lik bir Hg seviyesi ve ≤35.5'lik bir Hct seviyesi, cut-off değeri olarak güvenle kullanılabilir.

Anahtar Kelimeler

• geriatrik kalça kırıkları
• kan transfüzyonu
• cut-off değer
• prediktörler

Kaynakça

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