Using Fracture Patterns and Planned Operative Modality to Identify Fractured Neck of Femur Patients at High Risk of Blood Transfusion.

Abstract

BackgroundFractured neck of femurs is common, serious injuries usually requiring operative management. Red blood cell transfusions are often required to treat perioperative anaemia, but these are not without adverse effects.Aims and objectivesThe aim of this study is to identify subgroups of fractured neck of femur patients more likely to require red blood cell transfusions. We try to identify targeted strategies to reduce blood transfusion-associated adverse effects and thus improve outcomes.Design and methodsA retrospective cohort study of 324 patients. Patients were divided into cohorts based on radiological fracture patterns and operations performed. Data were collected from patient records, picture archiving and communication systems, the local transfusion laboratory, and the national hip fracture database. The primary outcome was blood transfusion rates in different fracture patterns in fractured necks of femur patients. The secondary outcome was blood transfusion rates in different operation types for fractured neck of femur patients. Chi-squared tests for independence were performed.Results14.9%, 34.7% and 33.3% of patients with intracapsular, intertrochanteric and subtrochanteric fractures, respectively, received blood transfusions. There was a significant relationship between fracture pattern and blood transfusion (X2 (2, N = 324) = 17.1687, p = 0.000187).47% of patients receiving long intramedullary nails, 45% of short intramedullary nails, 27% of open reduction internal fixations, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions. There was a significant relationship between operative modality and blood transfusion (X2 (4, N = 302) = 22.0184, p = 0.000199).ConclusionIn patients who have sustained a fractured neck of the femur, the fracture pattern and operative modality are both independently associated with the rates of red blood cell transfusion. In these identified groups, we propose that increased vigilance and awareness regarding transfusion avoiding strategies are utilised with the goal of improving patient outcomes.