Effects of perioperative function exercises on hidden blood loss in elderly patients with hip hemi-arthroplasty

Abstract

Objective To investigate the effects of initiative and passive perioperative function exercises on hidden blood loss (HBL) in hip hemi-arthroplasty. Methods Two hundred and eight elderly patients (78 males and 130 females) with femoral neck fractures aged 70-90 years (average age of 81.75±8.83) from January 2010 to June 2015 underwent hip hemi-arthroplasty at the 81th Hospital Affiliated Nanjing University of Chinese Medicine. According to the intensity and the manner of perioperative function exercises, patients were randomly divided into four groups: group A (no or little initiative function exercises), group B (little initiative and passive function exercises), group C (normal initiative function exercises) and group D (normal initiative and passive function exercises). The true total blood loss, HBL and their proportion on the original blood volume and total blood loss was calculated depending on height, weight, intra-operative blood loss, post-operative blood loss, pre- and post-operative hematocrit and blood transfused. According to the proportion of mean HBL on total blood loss, patients were divided into low HBL group and high HBL group. Then, the correlations between HBL and function exercises were analyzed. Results There was no statistically significant difference between pre-operative hematocrit and intra-operative blood loss. The true total blood loss and its proportion on the original blood volume, the HBL and its proportion on total blood loss was all gradually reduced by the increase intensity of initiative function exercises and the increase intensity of passive function exercises (F=7.980, 34.934, 50.430, 25.850, all P values<0.05). The true total blood loss was 976.92 mL, and the mean HBL was 452.94 mL, 46.36% of the total blood loss. According to the proportion of mean HBL on total blood loss (46.36%), 116 patients were found to have low HBL(≥46.36%), and 92 patients high HBL(<46.36%). The prevalence of high HBL was gradually diminished by the increase intensity of initiative and passive function exercises (P<0.05). Conclusions The intensity and the manner of perioperative function exercises are strongly associated with the HBL in elderly patients with hip hemi-arthroplasty. The initiative combined with the passive function exercises can be effectively prevent and reduce the incidence of high HBL. Key words: Aged; Femoral neck fractures; Arthroplasty, replacement, hip; Perioperative period; Geriatrics; Post-operative hemorrhage; Function exercises