Identify the trends of post-operative haemoglobin level change and risk factors for blood transfusions in surgically managed neck of femur fractures

Introduction

Neck of femur fracture (NOFF) is a major public health issue and there is a hidden blood loss during the surgery for the NOFF.

Objectives

To identify the trend of post-op anaemia and risk factors for blood transfusions in surgically managed Neck of femur fractures (NOFF).

Materials and methods

A prospective cohort analysis of 69 surgically managed NOFF patients was done for a period of 4 months. Age, sex, comorbidities, delay of admission, delay of surgery, type of fracture, level of the surgeon and diet of the patient were considered as risk factors for blood transfusions (BT). Pre-op and post-op day 1 and 3 Haemoglobin (Hb) and Haematocrit (Hct) values were assessed.

Results

Out of 69 patients who underwent surgery for NOFF, 28.9 % (n=20) received blood transfusions at some point of their management. Among non-transfused patients a significant decrease in Hb in post-op day 1 (mean drop =1.06 [95% CI = (0.807, 1.317) (P < 0.05) and further significant drop from post-op day 1 to 3 (mean drop = 0.77 [95% CI = (0.556, 0.984) (P < 0.05) was noted. In Hct a similar pattern noted recording a 2.93 [95% CI = (2.131, 3.722) (P < 0.05)] mean drop in post-op day 1 and a mean drop of 2.20 [ 95% CI = (1.411, 2.992) (P < 0.05) from postop day 1 to 3. Except for the fracture type (p = 0.02) none of the other factors as, age of the patient (p = 0.93), delay of admission (p = 0.09), delay of surgery (p = 0.16), blood group (p = 0.34), level of the surgeon who performed the surgery (p = 0.51), dietary pattern (p = 0.27) the comorbidities (p = 0.5, 1.0, 1.0) had any significant impact for transfusion.

Conclusion

Hb level continues to drop even on post-operative day 3. Postop Hb drop is partly due to haemodilution and extra capsular fractures has a higher risk of blood transfusion than intracapsular NOFF.