The impact of nutritional status variation on perioperative hidden blood loss in elderly patients with hemiarthroplasty

Abstract

Objective To investigate the viability of mini nutritional assessment (MNA) score on the nutritional status, and to observe the effects of nutritional status on hidden blood loss (HBL). Methods A retrospective study of 202 elderly patients with hip fractures aged 70-95(81.3±8.5) from January 2010 to May 2015 was performed at the 81th Hospital Affiliated Nanjing University of Chinese Medicine. By MNA, patients were randomly divided into three groups: well-nourishment group, malnourishment at risk group and malnourishment group. The variation of serological examinations in each group was compared, and the variation of malnutrition incidence was compared via nutritional evaluation results assessed by serological examinations albumin(ALB), prealbumin(PA), transferring albumen(TRA), and the lymphocyte percentage(TLP). The results were also used to analyze the correlations among MNA score and serological examinations. The true total blood loss and its proportion on original blood volume, the HBL and its proportion on 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 hidden blood loss(HBL) on total blood loss, patients were divided into low and high HBL group, and the occurrence of post-operative high HBL was analyzed in each group. Results The PA and TLP in well-nourishment group, TRA and TLP in malnourishment at risk group, and PA, TRA, TLP in malnourishment group were all significantly lower than those in the preoperative results (all P values 0.05), while the postoperative incidence of malnutrition in malnourished patients was obviously higher than that in the preoperative results (all P values<0.05). Group comparison of malnutrition incidence: the preoperative and postoperative incidence of malnutrition assessed by serological examinations was increased with the deterioration of nutritional status (all P values<0.05). The MNA score varied from 10-27 points with an average of (18.62 ± 3.25) points, and showed strong correlations with nutritional evaluation results assessed by serological examinations ALB, PA, TRA, and TLP (all P values<0.05). The true total blood loss, the dominant blood loss, the HBL and its proportion on total blood loss, and the prevalence of high HBL were all increased with the deterioration of nutritional status (all P values<0.05). Conclusions The MNA is the reliable method for evaluating the nutrition status of the elderly hip fracture patients, and the lower the MNA score, the higher the perioperative incidence of malnutrition, and the incidence of perioperative high HBL will be increased in elderly hip fractures patients with poor nutritional status when they are performed the hemiarthroplasty. Key words: Femoral neck fractures; Malnutrition; Arthroplasty, replacement; Perioperative; Hidden blood loss.