Predictive factors for transfusion requirements in patients over 65 years old with subcapital hip fracture

BACKGROUND AND OBJECTIVE: Our goal was to know the patient's clinical and hematologic characteristics that could influence the use of blood in subcapital hip fracture (SCHIF). PATIENTS AND METHOD: A prospective study of all patients affected by SCHF having surgery during 1998. Patients younger than 65 years, with primary blood diseases or under anticoagulation therapy were excluded. Age, gender, elapsed time, type of SCHIF (international AO classification), surgical procedure (nail vs. hip arthroplasty), transfusional procedure and total used; hemoglobin (W and hematocrit (Hct) levels at days 0 and + 2 (if surgical procedure was not performed) and after surgery were studied. Also we analyzed different hematimetric parameters: VCM, HCM, and RDW, transfusional act, and blood consume. Statistical univariant analysis included T-Student test for numeric variables and Pearson X2 test for string variables. Statistical significance differences were considered when p < 0.05. A multivariate stepwise logistic regression model was carried out. RESULTS: 75 patients with SCHF were studied: 18 B1, 8 B2 and 49 B3 according to AO classification. Male/female: 12/63; age 81(SD: 8) years (range 65-99). At the admission day, the Hb level was 128 (SD: 23) g/L; Hct 0.39 L/L (SD: 0.06) (range 13-52), HCM 30.3 pg, VCM 91.4 fL and RDW 14.3%. The elapsed time was 5 (SO: 2.8) days. 22 patients (29.3%) had anemia on admission. Surgery consisted of: nails in 23 (31%) and hip arthroplasty in 52 (69%) patients. At day + 2 (n: 36) Hb was 119 g/L (SD: 12) and Hct 0.36 L/L (SO: 0.04). 34 (45%) patients were not transfused. On the statitiscal univariant study, Hb and Hct levels at admission and after surgery, RDW (anisocytosis), type of fracture and the surgical act were all associated with a transfusional procedure. In the transfused patients the Hb level (119.9 g/L) was lower than in non-transfused ones (138 g/L) (p < 0.01). 71% hip arthroplasty patients were transfused vs 17% nail patients (p < 0.01). On the logistic regression only the preoperative Hb level (p < 0.01) was identified as an independent predictor of transfusion. CONCLUSIONS: These results invite us to improve the hematological parameters in this elderly population and to promote earlier and less aggressive surgical procedures (nails) and to promote the use of alternatives methods to reduce the use of allogenic blood.