Analysis of The Risk Factors for Postoperative Allogenic Blood Transfusion Requirement in Intertrochanteric Femur Fractures

Abstract

PURPOSE OF THE STUDY Hemoglobin (Hb) levels tend to decrease in patients after hip fractures. There are several factors that is responsible for this decrease in Hb levels. The primary aim in this study was to evaluate the risk factors of blood loss in patients with IFF and to determine the limits that may require allogeneic blood transfusion (ABT), and the secondary aim was to prevent unnecessary blood crossing outside these limits. MATERIAL AND METHODS 119 patients with intertrochanteric femur fracture (IFF) were included in the study. The patients were divided into two groups according to the use of ABT in the postoperative period. Age, gender, fracture side, height, weight, body mass index (BMI), American Society of Anesthesiologist (ASA) score, preoperative hemoglobin (Hb) level, platelet (Plt) number, Inter-national Normalized Ratio (INR), prothrombin time (PT), activated partial thromboplastin time (aPTT) values, comorbid dis-eases, history of drug use, whether ABT was applied in the preoperative period or not, and the postoperative 1st day Hb levels were evaluated from the medical records. A p value below than 0.05 was accepted as statistically significant. RESULTS Advanced age [odds ratio (OR) 1.069, 95% confidence interval (CI) 0.372–3.202], unstable fracture type [OR 0.258, 95% CI 0.496–6.632], and hemoglobin level <11 g/dL [OR 5.574, 95% GA 0.312–65.278 was found to be an independent pre-dictive risk factor for allogeneic blood transfusion requirement in the postoperative period. DISCUSSION There are several factors that is responsible for decrease in Hb levels in patients after hip fractures. The most important and most likely cause of these is the fracture itself. Other reasons are stated as type of fracture, time elapsed until the surgical treatment, preferred implants for treatment, advanced age, mean preoperative Hb value and anticoagulant drug usage in literature. Although the preoperative blood loss due to trauma is inevitable, unnecessary aggressive and/or inadequate treatments can be avoided if patients with higher bleeding risk and complication rate can be detected. CONCLUSIONS Advanced age, unstable fracture pattern and low preoperative Hb values should be considered as risk factors for the postoperative ABT requirements for patients with IFF.