What Is the Influence of a Delay to Surgery >24 Hours on the Rate of Red Blood Cell Transfusion in Elderly Patients With Intertrochanteric or Subtrochanteric Hip Fractures Treated With Cephalomedullary Nails?

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Abstract

Objectives:

To evaluate the influence of delay to surgery >24 hours on the rate of red blood cell transfusion in a selected population of hip fracture patients.

Design:

Cohort study.

Setting:

Tertiary care university hospital.

Patients:

A consecutive series of 987 patients (714 females) with a mean age of 86.3 (range 50–106) years operated with an intramedullary nail due to an unstable intertrochanteric or subtrochanteric hip fracture.

Intervention:

Patients operated with an intramedullary nail due to an unstable intertrochanteric or subtrochanteric hip fracture.

Main Outcome Measures:

Red blood cell transfusion rate, mortality, and postoperative length of stay were analyzed. Logistic regression analysis was used to adjust for anticoagulants, acetylsalicylic acid class, fracture type, preoperative hemoglobin (Hb) value, and time to surgery. Follow-up time was 1 year.

Results:

There was an increased preoperative transfusion rate among patients delayed for more than 24 hours to surgery (22%), compared with those operated within 24 hours (6.1%) (P < 0.001). After adjusting for anticoagulants, acetylsalicylic acid class, fracture type, preoperative Hb value, and time to surgery, it was found that anticoagulants [relative risk (RR), 2.0; confidence interval (CI), 1.1–3.5] and surgery delayed for more than 24 hours (RR, 3.9; CI, 2.3–6.1) were significantly associated with an increased rate of preoperative transfusions, although an increasing preoperative Hb value was associated with a lower rate of transfusions (RR, 0.3; CI, 0.2–0.4).

Conclusion:

We found an increased rate of preoperative transfusions among patients with unstable intertrochanteric or subtrochanteric hip fractures operated with an intramedullary nail that were delayed for surgery more than 24 hours.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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