We propose a method of predicting patients likely to be transfused and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.
📌 3 Key Takeaways
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Objective & Hypothesis:Objective: The aim of this study was to analyze the changes of hemoglobin levels in patients undergoing fixation for femoral neck fracture.Methods: Peroperative hemoglobin levels of patients who underwent either dynamic hip screw (DHS) fixation (n=74; mean age: 80 years) or hip hemiarthroplasty (n=104; mean age: 84 years) for femoral neck fracture was monitored.Results: There was a statistically and clinically significant mean drop of 31.1 g/L between the preoperative (D0) and postoperative Day 5 Hb levels (p<0.001), with significant reductions from D0 to Day 1 and Day 1 to Day 2 (p<0.001).
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Key Findings & Data:At each postoperative measurement, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p=0.046).Conclusion: The decrease in hemoglobin in the first 24-hour postoperative period (D0 to Day 1) is an underestimation of the ultimate lowest value in hemoglobin found at Day 2.
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Conclusion & Impact:We propose a method of predicting patients likely to be transfused and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Domain Parameters
Abstract
Objective: The aim of this study was to analyze the changes of hemoglobin levels in patients undergoing fixation for femoral neck fracture.Methods: Peroperative hemoglobin levels of patients who underwent either dynamic hip screw (DHS) fixation (n=74; mean age: 80 years) or hip hemiarthroplasty (n=104; mean age: 84 years) for femoral neck fracture was monitored.Results: There was a statistically and clinically significant mean drop of 31.1 g/L between the preoperative (D0) and postoperative Day 5 Hb levels (p<0.001), with significant reductions from D0 to Day 1 and Day 1 to Day 2 (p<0.001). At each postoperative measurement, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p=0.046).Conclusion: The decrease in hemoglobin in the first 24-hour postoperative period (D0 to Day 1) is an underestimation of the ultimate lowest value in hemoglobin found at Day 2. Relying on the Day 1 hemoglobin level could be detrimental to patient care. We propose a method of predicting patients likely to be transfused and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.
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Cite This Article
NAGRA, N. S., POPTA, D. V., WHITESIDE, S., HOLT, E. M. (2016). Postoperative hemoglobin level in patients with femoral neck fracture. Acta Orthopaedica et Traumatologica Turcica, Cilt: 50 - Sayı: 3, 315–322. https://ajindex.com/articles/353536
References (11)
Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C. A systematic review of hip fracture inci- dence and probability of fracture worldwide. Osteoporos Int 2012;23:2239-56.
Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuo- ri I, Järvinen M. Epidemiology of hip fractures. Bone 1996;18(1 Suppl):57-63. Ensrud KE. Epidemiology of fracture risk with advancing age. J Gerontol A Biol Sci Med Sci 2013;68:1236-42. Zaveri KG. The medical consultant's role in caring for pa- tients with hip fracture. Ann Intern Med 1999;130:76-7.
Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of co- morbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observa- tional cohort study. BMJ 2005;331:1374. National Institute for Health and Clinical Excellence. Quality Standard for Hip Fracture. Available from: http:// www.nice.org.uk/guidance/qs16/chapter/about-this- quality-standard. Accessed May 2015.
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 frac- ture. J Orthop Trauma 2004;18:369-74.
Gruson KI, Aharonoff GB, Egol KA, Zuckerman JD, Koval KJ. The relationship between admission hemoglo- bin level and outcome after hip fracture. J Orthop Trauma 2002;16:39-44.
Ho CA, Li CY, Hsieh KS, Chen HF. Factors determining the 1-year survival after operated hip fracture: a hospital- based analysis. J Orthop Sci 2010;15:30-7.
Maxwell MJ, Moran CG, Moppett IK. Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery. Br J Anaesth 2008;101:511-7.
Shander A, Knight K, Thurer R, Adamson J, Spence R. Prevalence and outcomes of anemia in surgery: a system- atic review of the literature. Am J Med 2004;116:58-69.
Enko D, Wallner F, von-Goedecke A, Hirschmugl C, Auersperg V, Halwachs-Baumann G. The impact of an algorithm-guided management of preoperative anemia in perioperative hemoglobin level and transfusion of major orthopedic surgery patients. Anemia 2013;2013:641876. Björkelund KB, Hommel A, Thorngren KG, Lundberg D, Larsson S. Factors at admission associated with 4 months outcome in elderly patients with hip fracture. AANA J 2009;77:49-58.
Oztürk A, Ozkan Y, Akgöz S, Yalçyn N, Ozdemir RM, Aykut S. The risk factors for mortality in elderly patients with hip fractures: postoperative one-year results. Singa- pore Med J 2010;51:137-43.