Factors Affecting the Perioperative Blood Transfusion Need in Geriatric Hip Fractures

Yıl 2022, , 814 - 821, 28.11.2022

Mustafa Kavak , Cüneyd Günay

https://doi.org/10.20515/otd.1163135

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

• 1. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006 Dec;17(12):1726-33.
• 2. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992 Nov;2(6):285-9.
• 3. Adunsky A, Lichtenstein A, Mizrahi E, Arad M, Heim M. Blood transfusion requirements in elderly hip fracture patients. Arch Gerontol Geriatr. 2003 Jan-Feb;36(1):75-81.
• 4. Farahmand BY, Michaëlsson K, Ahlbom A, Ljunghall S, Baron JA; Swedish Hip Fracture Study Group. Survival after hip fracture. Osteoporos Int. 2005 Dec;16(12):1583-90.
• 5. Halm EA, Wang JJ, Boockvar K, Penrod J, Silberzweig SB, Magaziner J, et al. The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture. J Orthop Trauma. 2004 Jul;18(6):369-74.
• 6. Lawrence VA, Silverstein JH, Cornell JE, Pederson T, Noveck H, Carson JL. Higher Hb level is associated with better early functional recovery after hip fracture repair. Transfusion. 2003 Dec;43(12):1717-22.
• 7. Carson JL, Altman DG, Duff A, Noveck H, Weinstein MP, Sonnenberg FA, et al. Risk of bacterial infection associated with allogeneic blood transfusion among patients undergoing hip fracture repair. Transfusion. 1999 Jul;39(7):694-700.
• 8. Levi N, Sandberg T. Blood transfusion and postoperative wound infection in intracapsular femoral neck fractures. Bull Hosp Jt Dis. 1998;57(2):69-73.
• 9. Koval KJ, Rosenberg AD, Zuckerman JD, Aharonoff GB, Skovron ML, Bernstein RL, et al. Does blood transfusion increase the risk of infection after hip fracture? J Orthop Trauma. 1997 May;11(4):260-5; discussion 265-6.
• 10. Carson JL, Hill S, Carless P, Hébert P, Henry D. Transfusion triggers: a systematic review of the literature. Transfus Med Rev. 2002 Jul;16(3):187-99.
• 11. Khan AM, Mushtaq N, Giannakas K, Sochart DH, Andrews JG. Cross-match protocols for femoral neck fractures--finding one that can work. Ann R Coll Surg Engl. 2004 Jan;86(1):11-4.
• 12. Muñoz M, Leal-Noval SR. Restrictive transfusion triggers in major orthopaedic surgery: effective and safe? Blood Transfus. 2013 Apr;11(2):169-71.
• 13. Carow J, Carow JB, Coburn M, Kim BS, Bücking B, Bliemel C, et al. Mortality and cardiorespiratory complications in trochanteric femoral fractures: a ten year retrospective analysis. Int Orthop. 2017 Nov;41(11):2371-2380.
• 14. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am. 1999 Jan;81(1):2-10.
• 15. Goodnough LT, Shander A, Brecher ME. Transfusion medicine: looking to the future. Lancet. 2003 Jan 11;361(9352):161-9.
• 16. Dodd RY. Current estimates of transfusion safety worldwide. Dev Biol (Basel). 2005;120:3-10.
• 17. Foss NB, Kristensen MT, Kehlet H. Anaemia impedes functional mobility after hip fracture surgery. Age Ageing. 2008 Mar;37(2):173-8.
• 18. Hou G, Zhou F, Tian Y, Ji H, Zhang Z, Guo Y, et al. Predicting the need for blood transfusions in elderly patients with pertrochanteric femoral fractures. Injury. 2014 Dec;45(12):1932-7.
• 19. Shokoohi A, Stanworth S, Mistry D, Lamb S, Staves J, Murphy MF. The risks of red cell transfusion for hip fracture surgery in the elderly. Vox Sang. 2012 Oct;103(3):223-30.
• 20. Kadar A, Chechik O, Steinberg E, Reider E, Sternheim A. Predicting the need for blood transfusion in patients with hip fractures. Int Orthop. 2013 Apr;37(4):693-700.
• 21. Swain DG, Nightingale PG, Patel JV. Blood transfusion requirements in femoral neck fracture. Injury. 2000 Jan;31(1):7-10.
• 22. Bajs ID, Cvjetko I, Vicić VK, Skodlar J. Transfuzijsko lijecenje bolesnika s pertrohanternim prijelomom femura [Blood transfusion in patients with pertrochanteric femoral fracture]. Acta Med Croatica. 2006;60(1):7-10. Croatian.
• 23. Cuenca J, García Erce JA, Martínez AA, Solano VM, Herrera A. Valores hematimétricos preoperatorios y tipo de fractura como factores de riesgo transfusional en fracturas trocantéreas de cadera en pacientes mayores de 65 años [Preoperative blood test results and type of fracture as transfusional risk factors in patients older than 65 years with trochanteric hip fracture]. Rev Esp Anestesiol Reanim. 2004 Nov;51(9):515-22. Spanish.
• 24. Robbins J, Steingold RF. Blood use in urgent operations for patients with fractures of the femoral neck. Injury. 1986 Jul;17(4):265-6.
• 25. Kurdy NM, Hokan R. A cross-matching policy for fractures of the proximal third of the femur. Injury. 1993 Sep;24(8):521-4.
• 26. Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture. J Bone Joint Surg Br. 2006 Aug;88(8):1053-9.
• 27. Bian FC, Cheng XK, An YS. Preoperative risk factors for postoperative blood transfusion after hip fracture surgery: establishment of a nomogram. J Orthop Surg Res. 2021 Jun 23;16(1):406.
• 28. Johnston P, Wynn-Jones H, Chakravarty D, Boyle A, Parker MJ. Is perioperative blood transfusion a risk factor for mortality or infection after hip fracture? J Orthop Trauma. 2006 Nov-Dec;20(10):675-9.