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DOI: 10.1055/s-0044-1785520
Evaluation of a Blood Reserve Protocol for Hip Fracture Surgery in the Elderly
Article in several languages: português | English Financial Support The authors declare that they did not receive funding from agencies in the public, private, or not-for-profit sectors for the conduction of the present study.
Abstract
Objective To identify the predictive factors for the need for transfusion during and after surgery to treat hip fractures in the elderly and to evaluate a protocol to guide the request for blood reserves for surgery.
Methods The medical records of 172 elderly patients undergoing surgical treatment for proximal femoral fractures were collected. Data on sex, age, preoperative hemoglobin level, diagnosis, and type of surgery were tested for correlation with blood transfusion. In our sample, we determined the number of units of packed red blood cells reserved, the transfusion rate, and the cross-test:transfusion ratio. We made the same calculations in a hypothetical situation in which the request for blood reserves for our sample followed the criteria of a defined protocol.
Results We found a correlation between the American Society of Anesthesiologists (ASA) classification and the occurrence of transfusions, and an inverse correlation between the hemoglobin level on admission and the number of bags transfused. A reserve of 328 units of packed red blood cells was requested for 167 surgeries. Had the proposed protocol been applied, 72 units would have been requested for 61 surgeries.
Conclusion We found a correlation regarding the variables ASA classification and preoperative hemoglobin level and the occurrence of transfusion. Applying a proposed protocol to decide between requesting a reserve and only typing for elderly individuals undergoing surgical treatment for hip fracture proved suitable to reduce the number of packed red blood cell reserves.
Work carried out at the Irmandade da Santa Casa de Londrina, Londrina, Paraná, Brazil.
Publication History
Received: 15 November 2023
Accepted: 15 January 2024
Article published online:
04 September 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
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Referências
- 1 Adeyemi A, Delhougne G. Incidence and Economic Burden of Intertrochanteric Fracture: A Medicare Claims Database Analysis. JBJS Open Access 2019; 4 (01) e0045
- 2 Van Heghe A, Mordant G, Dupont J, Dejaeger M, Laurent MR, Gielen E. Effects of Orthogeriatric Care Models on Outcomes of Hip Fracture Patients: A Systematic Review and Meta-Analysis. Calcif Tissue Int 2022; 110 (02) 162-184
- 3 Arliani GG, Astur DC, Linhares GK, Balbachevsky D, Fernandes HJA, Reis FB. Correlação entre tempo para o tratamento cirúrgico e mortalidade em pacientes idosos com fratura da extremidade proximal do fêmur. Rev Bras Ortop 2011; 46 (02) 189-194
- 4 Yassa R, Khalfaoui MY, Hujazi I, Sevenoaks H, Dunkow P. Management of anticoagulation in hip fractures: A pragmatic approach. EFORT Open Rev 2017; 2 (09) 394-402
- 5 Selim A, Ponugoti N, Naqvi AZ, Magill H. Cephalo-medullary nailing versus dynamic hip screw with trochanteric stabilisation plate for the treatment of unstable per-trochanteric hip fractures: a meta-analysis. J Orthop Surg Res 2021; 16 (01) 47
- 6 Carson JL, Altman DG, Duff A. et al. Risk of bacterial infection associated with allogeneic blood transfusion among patients undergoing hip fracture repair. Transfusion 1999; 39 (07) 694-700
- 7 Brunskill SJ, Millette SL, Shokoohi A. et al. Red blood cell transfusion for people undergoing hip fracture surgery. Cochrane Database Syst Rev 2015; (04) CD009699
- 8 Garcia PBJ, Carvalho P. Manual de Transfusão Sanguínea para Médicos. 2017 . Disponível em: http://www.hcfmb.unesp.br/wp-content/uploads/2018/01/MANUAL-DE-TRANSFUSÃO-SANGUÍNEA-PARA-MÉDICOS.pdf
- 9 Bastos F. Guia para uso de hemocomponentes [Internet]. Ministerio da saude; 2015. . Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/guia_uso_hemocomponentes_2ed.pdf
- 10 Isidoro REC, Silva KFN, Oliveira JF, Barichello E, Pires PS, Barbosa MH. Blood orders and predictors for hemotransfusion in elective femur fracture repair surgery. Texto Contexto Enferm 2019; 28: e20180129
- 11 Roth F, Birriel FC, Barreto DF. et al. Transfusão sanguínea em artroplastia de quadril: a curva laboratorial hemática deve ser o único preditor da necessidade de transfusão?. Rev Bras Ortop 2014; 49 (01) 44-50
- 12 Kadar A, Chechik O, Steinberg E, Reider E, Sternheim A. Predicting the need for blood transfusion in patients with hip fractures. Int Orthop 2013; 37 (04) 693-700
- 13 Kurdy NM, Hokan R. A cross-matching policy for fractures of the proximal third of the femur. Injury 1993; 24 (08) 521-524
- 14 Khan AM, Mushtaq N, Giannakas K, Sochart DH, Andrews JG. Cross-match protocols for femoral neck fractures–finding one that can work. Ann R Coll Surg Engl 2004; 86 (01) 11-14