Comparison of perioperative hidden blood loss and analysis of risk factors in elderly patients with femoral intertrochanteric fractures with intramedullary fixation at different altitudes

Abstract

Objective: To compare the perioperative hidden blood loss (HBL) and analyze its risk factors in elderly patients undergoing intramedullary fixation after intertrochanteric fractures at different altitudes. Materials and methods: This prospective study collected the perioperative clinical data of 120 elderly femoral intertrochanteric fractures from February 2020 to February 2021 at different altitudes. Twenty-nine cases were from Nanjing, where an average altitude is 10 m (group A); 73 patients were from Xining, where an average altitude is 2300 m (group B); and 20 cases were from Yushu where an average altitude is 3600 m (group C). Demographic data of the included patients, preoperative and postoperative hemoglobin, hematocrit, prothrombin time (PT), activated partial thromboplastin time (APTT), preoperative and postoperative HBL, intraoperative visible blood loss, and perioperative blood transfusion rate, and other relevant indicators were recorded and the clinical data of the 3 groups were summarized. Results: The total HBL, preoperative HBL, and postoperative HBL of group C were greater than those of groups A and B, that is, total HBL: 740±380 mL in group A versus 850±530 mL in group B versus 1090±180 mL in group C, F=3.551, P=0.032; preoperative HBL: 460±320 mL in group A versus 410±300 mL in group B versus 590±120 mL in group C, F=9.086, P=0.011; Postoperative HBL: 270±220 mL in group A versus 440±420 mL in group B versus 500±140 mL in group C, F=13.138, P=0.001. Multiple linear regression analysis found that admission PT and APTT, fracture classification AO/OTA 31-A2.2–A3.3, male, body mass index, intraoperative blood transfusion, injury to operation time >5 days, longer operation time, and high altitude all were independent risk factors for perioperative HBL increase. There was a negative correlation between low altitude and hemoglobin on the first postoperative day and HBL. Conclusion: Elderly patients undergoing intramedullary fixation after intertrochanteric fractures develop massive HBL during the perioperative period, especially in patients in high altitude areas. Regular blood tests, PT, APTT during the perioperative period are vital to avoid perioperative anemia. Shortening the perioperative period and operation time will significantly reduce HBL.