OTA 2012 Posters

Scientific Poster #28 Hip/Femur OTA-2012

The Hidden Blood Loss After Hip Fracture

Samuel G. Molyneux, MSc, MRCS; G. Brown, MRCS; Timothy O. White, MD, FRCS(Orth);
New Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom

Background/Purpose: A significant proportion of the blood loss related to hip fractures occurs prior to surgery. Despite advances in surgical and anesthetic techniques the mortality after hip fracture has not significantly changed in the last 40 years. Preoperative anemia is a risk factor for perioperative death. Identifying patients at risk of preoperative anemia can facilitate appropriate medical optimization. This study attempts to quantify the blood loss associated with the initial hip injury prior to surgery.

Methods: This was a prospective study. All patients with a diagnosis of hip fracture presenting to our unit were included. Admission information included: fracture classification, hemoglobin (Hb) , electrolytes, and urea on admission, length of time between injury and presentation, domiciliary status, drug history, and patient comorbidities. All patients then had a repeat blood test (Hb, urea, and electrolytes) in the anesthetic room immediately prior to surgery. Patients with a preinjury diagnosis of anemia, on anticoagulation, and with gastrointestinal bleeds were excluded from this study.

Results: 83 hip fracture patients were included in the study. There were 35 intracapsular fractures and 48 extracapsular. All patients underwent operation within 48 hours. The mean age was 76 years (range, 53-91). There were 56 women and 27 men. There was a universal fall in preoperative Hb (range, 2.2-33 g/L). The mean Hb drop in the extracapsular and intracapsular fracture groups was 13.8 g/L and 8.2 g/L, respectively (P <0.05). The only predictor of fall in Hb was age, with younger patients suffering a larger fall in Hb than older patients (mean Hb drop = 16.1 in <70 years, 12 in 70 to 79 years, 8.3 in 80 to 91 years). There were no corresponding changes in urea or electrolytes to suggest this was a purely dilutional effect from fluid administration.

Conclusions: Hip fracture patients have a large drop in hemoglobin that is associated with the initial trauma rather than the operation. This highlights the need for anesthetic and orthopaedic staff to be vigilant to the risk of preoperative anemia in this cohort of frail patients even when the initial hemoglobin is apparently normal.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.