D'Amore Taylor, Loewen Michael, Gorczyca Michael T, Judd Kyle, Ketz John P, Soles Gillian, Gorczyca John T
University of Rochester School of Medicine and Dentistry, Rochester, NY.
Comox Valley Hospital, Comox, BC, Canada.
OTA Int. 2020 Jul 29;3(3):e083. doi: 10.1097/OI9.0000000000000083. eCollection 2020 Sep.
Most patients can tolerate a hemoglobin (Hgb) > 8 g per deciliter. In some cases, however, transfusion will delay physical therapy and hospital discharge. This study aims to review Hgb and transfusion data for a large volume of recent hip fracture patients in order to identify new opportunities for decreasing the length of hospital stay. Our hypotheses are that in some cases, earlier transfusion of more blood will be associated with shorter hospital stays, and that Hgb levels consistently decrease for more than 3 days postoperatively.
Retrospective chart review.
Two academic medical centers with Geriatric Fracture Programs.
Data was collected from patients 50 years and older with hip fractures April 2015 and October 2017.
Operative stabilization of the hip fractures according to standard of care for the fracture type and patient characteristics. Transfusion according to established standards.
Electronic records were retrospectively reviewed for demographic information, Hgb levels, and transfusion events.
One thousand fifteen patients with femoral neck or intertrochanteric hip fractures were identified. Eight hundred sixty met the inclusion criteria. The average length of hospital stay was 6.7 days. The mean patient age was 82 years. The average American Society of Anesthesiologists score was 2.9. The average Hgb level consistently decreased for 5 days postoperatively before beginning to increase on day 6. There was poor consistency between intraoperative Hgb levels and preoperative or postoperative Hgb levels. Three hundred sixty-eight (42.8%) patients were transfused an average of 1.9 (range 1-6) units. One hundred five patients required a transfusion on postoperative day (POD) 1: 72 received only 1 unit of blood: 36 (50%) of the 72 required a second transfusion in the following days, compared to 9 of 33 (27%) who received 2 units on POD 1 (χ2 = 3.8898; < .05). Patients who received transfusions on POD 3 or later had an average length of stay >2.5 days longer than those who received a transfusion earlier ( = 0.005).
Our findings do not support earlier transfusion of more blood. Although in some cases, there is an association between earlier transfusion of more blood and shorter hospital stay, routine transfusion of more blood would incur higher transfusion risks in some patients who would not otherwise meet criteria for transfusion. After hip fracture surgery, the Hgb usually decreases for 5 days and does not begin to increase until POD 6. This information will provide utility in the population health management of hip fracture patients.
Level III, Retrospective Cohort Study.
大多数患者能够耐受血红蛋白（Hgb）大于每分升8克。然而，在某些情况下，输血会延迟物理治疗和出院时间。本研究旨在回顾大量近期髋部骨折患者的血红蛋白和输血数据，以寻找缩短住院时间的新机会。我们的假设是，在某些情况下，更早输注更多血液与缩短住院时间相关，并且术后血红蛋白水平会持续下降超过3天。
回顾性病历审查。
两个设有老年骨折项目的学术医疗中心。
收集了2015年4月至2017年10月期间年龄在50岁及以上的髋部骨折患者的数据。
根据骨折类型和患者特征的护理标准对髋部骨折进行手术固定。按照既定标准进行输血。
对电子记录进行回顾性审查，以获取人口统计学信息、血红蛋白水平和输血事件。
确定了1015例股骨颈或转子间髋部骨折患者。其中860例符合纳入标准。平均住院时间为6.7天。患者平均年龄为82岁。美国麻醉医师协会平均评分为2.9。术后血红蛋白水平平均持续下降5天，直到第6天开始上升。术中血红蛋白水平与术前或术后血红蛋白水平之间的一致性较差。368例（42.8%）患者平均输注了1.9（范围1 - 6）单位血液。105例患者在术后第1天（POD 1）需要输血：72例仅接受了1单位血液，其中72例中的36例（50%）在接下来的几天需要再次输血，而在POD 1接受2单位血液的33例中的9例（27%）需要再次输血（χ2 = 3.8898；P < 0.05）。在POD 3或更晚接受输血的患者平均住院时间比更早接受输血的患者长>2.5天（P = 0.005）。
我们的研究结果不支持更早输注更多血液。虽然在某些情况下，更早输注更多血液与缩短住院时间之间存在关联，但对一些原本不符合输血标准的患者进行常规更多输血会带来更高的输血风险。髋部骨折手术后，血红蛋白通常会下降5天，直到POD 6才开始上升。这些信息将有助于髋部骨折患者的人群健康管理。
III级，回顾性队列研究。
