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Overview :
Odumala et al identified risk factors for increased blood
loss during surgical management of a hip fracture. These can help identify which
patients may require more units of blood for transfusion. The authors are from
Southend General Hospital in Southend Essex, England.
Excessive blood loss was defined as a volume > 480 mL.
Risk factors identified on multivariate analysis:
(1) hemiarthroplasty
used to correct the fracture
(2) patients at
risk for cardiac or cerebral ischemia following volume depletion (see 05.13.07:
history of TIA, history of thrombotic stroke, coronary artery disease,
congestive heart failure, aortic stenosis or other hemodynamically significant
valvular heart disease)
Additional risk factors seen on the univariate analysis:
(1) ASA class III or IV
(2) >= 2 pre-existing comorbid conditions
Hemiarthroplasty has a number of interesting connotations:
(1) The alternative operative repair is placement of screws,
which is simpler.
(2) A hemiarthroplasty involves more extensive bone
preparation with risk for blood loss.
(3)
Hemiarthroplasty is done when screws are unlikely to work well. According to
Swionkowski, the following are indications for hemiarthroplasty:
(3a) pathologic
bone
(3b) rheumatoid
arthritis, chronic renal failure or other serious comorbid disease associated
with poor fracture healing
(3c) limited
lifespan (advanced physiologic age)
One factor not discussed is the coagulation status of the
patients. People identified as being at risk for excessive blood loss are also
patients who may be on anticoagulation prior to and after surgery.
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