Hidden blood loss and its risk factors after hip hemiarthroplasty for displaced femoral neck fractures: a cross-sectional study

Abstract

PurposeSeveral authors have reported the degree of total blood loss (TBL) following hemiarthroplasty for displaced femoral neck fracture; however, the research specifically investigating on hidden blood loss (HBL) after hip hemiarthroplasty is still lacking. The purpose of this study is to evaluate the HBL in patients who underwent hip hemiarthroplasty for displaced femoral neck fractures and to analyze its risk factors.Patients and methodsFrom January 2015 to December 2016, 212 patients (57 males and 155 females) with displaced femoral neck fracture undergoing hip hemiarthroplasty were included in this study. The demographic and relevant clinical information of the patients were collected. According to the Gross’s formula, each patient’s height, weight, and preoperative and postoperative hematocrit were recorded and used for calculating the total perioperative blood loss and HBL. Risk factors were further analyzed by multivariate linear regression.ResultsThe HBL was 525±217 mL, with 61.0%±13.6% in the total perioperative blood loss (859±289 mL), and the perioperative hemoglobin (Hb) loss was 23.8±7.4 g/L. Multivariate linear regression analysis revealed that HBL was positively associated with higher American Society of Anesthesiologists (ASA) classification (regression coefficient=62.169, 95% CI=15.616–108.722; P=0.009), perioperative gastrointestinal bleeding/ulcer (regression coefficient=155.589, 95% CI=38.095–273.083; P=0.010), and transfusion (regression coefficient=192.118, 95% CI=135.578–248.659; P<0.001). Compared with females, males had a risk of increased HBL (regression coefficient=87.414, 95% CI=28.547–146.280; P=0.004), and general anesthesia had an increased HBL compared with spinal anesthesia (regression coefficient=68.920, 95% CI=11.707–126.134; P=0.018).ConclusionHBL should not be ignored in patients who underwent hip hemiarthroplasty for displaced femoral neck fractures in the perioperative period, because it is a significant portion of TBL. Female patients, patients with higher ASA classification and perioperative gastrointestinal bleeding/ulcer, patients who were administered general anesthesia, or patients who underwent transfusion had a greater amount of HBL after hip hemiarthroplasty was performed. Having a correct understanding of HBL may help surgeons improve clinical assessment capabilities and ensure patients’ safety.

Comparison of the Effectiveness and Safety of Intravenous and Topical Regimens of Tranexamic Acid in Complex Tibial Plateau Fracture: A Retrospective Study

“…The topical regimen can effectively reduce TPD by approximately 12 mL, and there was signi cant difference compares with IV regimen; this conclusion was also reached by Artit et al 26 The IV regimen more effectively reduced the real Hb reduction during the perioperative period, similar to the results of Tzatzairis et al 27 Sehat et al 28 rst proposed the concept of HBL and studied the HBL of 63 patients that underwent TKA; they found that HBL accounted for approximately 50% of the TBL. Gao et al 29 found that the TBL of perioperative patients in hip replacement was approximately 859 mL, and the HBL was approximately 525 mL, which accounted for 61% of the TBL. Foss et al 30 studied the hidden blood loss after hip fracture and found that different surgical schemes caused a hidden blood loss of 500 mL to 1473 mL, which was approximately 2 to 3 times greater than the visible blood loss.…”

Incidence, Risk Factors, and Nomogram of Transfusion and Associated Complications in Nonfracture Patients following Total Hip Arthroplasty

“…In addition to the above risk factors, we found that the incidence of transfusion in patients with general anesthesia was higher than that in patients with nongeneral anesthesia. Previous studies have shown that blood loss was higher in patients who underwent general anesthesia than in patients under local anesthesia during hip arthroplasty [ 22 ]. In addition, the operation time was longer with local anesthesia, which may lead to an increased risk of blood transfusion [ 23 ].…”

Comparison of the effectiveness and safety of different regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

“…The topical regimen can effectively reduce TPD by approximately 12 mL, but there was no significant difference to intravenous application; this conclusion was also reached by Artit et al 26 The IV regimen more effectively reduced the real Hb reduction during the perioperative period, similar to the results of Tzatzairis et al 27 Sehat et al 28 first proposed the concept of HBL and studied the HBL of 63 patients that underwent TKA; they found that HBL accounted for approximately 50% of the TBL. Gao et al 29 found that the TBL of perioperative patients in hip replacement was approximately 859 mL, and the HBL was approximately 525 mL, which accounted for 61% of the TBL. Foss et al 30 studied the hidden blood loss after hip fracture and found that different surgical schemes caused a hidden blood loss of 500 mL to 1473 mL, which was approximately 2 to 3 times greater than the visible blood loss.…”