Study of gender difference on perioperative hidden blood loss of intertrochanteric fracture

Abstract

Objective To investigate the hidden blood loss of intertrochanteric fractures in different gender. Methods Data of 108 patients with intertrochanteric fractures who were admitted to the department of orthopaedics from January 2012 to December 2015 were retrospectively analyzed. For all patients who were composed of 42 males and 66 females and whose ages ranged from 32 to 95 years old, the average age was 75.4±10.8 years old. With the equation of Gross, the amount of perioperative hidden blood loss (PHBL) was calculated as well as the fraction of PHBL. The lineal regression model was utilized to analyze the correlations between PHBL and those factors including age, time interval between injury and surgery, injured side, Evans classification of intertrochanteric fractures, patients' ASA grade, and type of anesthesia. The difference of hemoglobin (Hb), hematocrit (Hct), total blood volume, the amount of PHBL, and the percentage of PHBL were respectively compared between male group and female group. Results PHBL had no correlation of lineal regression with age, time interval between injury and surgery, injured side, Evans classification of intertrochanteric fractures, patients' ASA grade, or the type of anesthesia. The share of PHBL did not have correlation of lineal regression with age, time interval between injury and surgery, injured side, Evans classification of inter-trochanteric fractures, patients' ASA grade, or the type of anesthesia as well. Lineal regressive correlation only existed between gender factor and the PHBL fraction of total blood volume, and there was no regressive correlation between gender factor and the amount of PHBL. In the male group, the mean amount of preoperative Hb was 121.8±16.6 g/L and preoperative Hct was averagely 36.7%±5.0%; in the female group, the amount of preoperative Hb was 99.5±13.1 g/L on average and the mean amount of Hct was preoperatively 30.6% ± 3.7%. Postoperatively, the mean amount of preoperative Hb was 103.4 ± 19.3 g/L and Hct was averagely 29.8%±4.2%; in the female group, the amount of postoperative Hb was 79.0±10.4 g/L on average and the mean amount of Hct was postoperatively 23.9%±2.6%. Significant difference of perioperative Hb and Hct was found between two groups. The total blood volume was averagely 4 500.6±191.5 ml in the male group and 3 607.0±235.7 ml in the females group. There was statistical difference between two groups. For male group, the amount of PHBL was 647.9±174.1 ml on average and accounted for 14.4%±4.0% of total blood volume. For the female group, the mean amount of PHBL was 694.8±216.5 ml and making up 19.3%±6.1% of the total blood volume. As for the amount of PHBL, no significant difference was observed between male group and female group, but there was statistical difference of the share of PHBL accounting for total blood volume between two groups. Conclusion Female patients' PHBL fraction of total blood volume is greater than male patients', therefore females' PHBL conditions need to be paid more attention to and ought to be corrected in time. Key words: Hip fractures; Fracture fixation, intramedullary; Perioperative period; Blood Loss, surgical; Postoperative hemorrhage