OTA 2013 Posters

Scientific Poster #29 Geriatric OTA 2013

Transfusion Practices in Geriatric Hip Fractures: A Survey of Orthopaedic Traumatologists and Residents

Collin J. May, MD1; Lauren K. Ehrlichman, MD1; Edward K. Rodriguez, MD, PhD2;
1Massachusetts General Hospital, Boston, Massachusetts, USA
2Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Background/Purpose: Recent evidence suggests that a restrictive strategy of transfusion has equivalent or improved outcomes to a liberal strategy of transfusion in patients following hip fracture, even in the setting of cardiovascular disease. It is unclear if this evidence has changed clinician transfusion practices toward a more restrictive approach in this patient population. This study aims to characterize the transfusion practices among a group of community and academic orthopaedic traumatologists as well as orthopaedic residents.

Methods: Survey questionnaires were sent out to all participants of the AO New England Regional Fracture Summit held in Stowe, Vermont in 2013 as well as all orthopaedic residents at our institution using an Internet-based survey system. A clinical vignette of a fictional hip fracture patient (a 75-year-old female with an unstable 3-part intertrochanteric hip fracture and a history of cardiovascular disease) was presented, and respondents were asked if they would transfuse the patient at five different intervals during the hospital course. Of the five clinical scenarios, only in the final one did the patient’s hemoglobin value and symptomatology meet the threshold for transfusion in a restrictive approach.

Results: 42 of 50 orthopaedic traumatologists (84%), and 44 of 60 orthopaedic residents (73%) polled responded to the questionnaire. Based on the clinical vignette provided, 83 of all 86 respondents (96%) favored transfusion in at least one clinical scenario that would not be supported under a restrictive transfusion protocol. When grouped by training level, 39 of 42 orthopaedic traumatolgists (93%) and 44 of 44 orthopaedic residents (100%) elected to transfuse in at least one scenario not supported under a restrictive transfusion protocol. In general, both groups tended toward increasing rates of transfusion as the fictional patient’s hemoglobin value dropped, even in the absence of symptoms, with 5 of 86 (6%) electing to transfuse at a hemoglobin value of 9.5, 38 of 86 (44%) at hemoglobin 8.5, and 70 of 86 (81%) at hemoglobin 7.1.

Conclusion: Despite evidence supporting the use of a restrictive transfusion protocol in the management of postoperative hip fracture patients, it has been our experience that these patients often are transfused prior to reaching a restrictive transfusion threshold. We polled orthopaedic trauma experts and orthopaedic residents at a major teaching hospital to see if they would take a restrictive or permissive approach. Among those polled, there was a near-uniform permissive approach to transfusion. The motivation for permissive transfusion strategy among clinicians was not the subject of this investigation, and further study is needed to elucidate what factors may play a role in influencing this decision.

• 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.