Shanxi Bethune Hospital, Shanxi Academy of Medical Science, No. 99, Longcheng Street, Taiyuan, 030032, Shanxi Province, China.
School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.
Int Orthop. 2022 Jul;46(7):1637-1645. doi: 10.1007/s00264-022-05347-8. Epub 2022 Feb 15.
Elderly patients with femoral neck fractures (FNFs) undergoing hemiarthroplasty usually have poor physical condition. The main aim of this study was to identify risk factors for blood transfusion in these patients and construct a nomogram to intuitively predict the requirement of transfusion. The secondary purpose was to examine the relationship between blood transfusion and complications within 30 days post-operatively. Our hypothesis was that chronic kidney disease (CKD) and hypoalbuminemia may increase the requirement of transfusion.
Data of 414 elderly patients undergoing hemiarthroplasty for FNFs were retrospectively collected. Univariate and multiple regression analysis were performed to identify independent risk factors for blood transfusion, which were used to construct a nomogram subsequently. The discrimination and calibration of the nomogram model were assessed with concordance index (C-index), the area under receiver operating characteristic curve (AUC), and calibration curve. Furthermore, the complications of blood transfusion within 30 days post-operatively were also analyzed.
Out of 414 patients, 127 (30.7%) received a blood transfusion. Independent risk factors for blood transfusion included CKD, hypoalbuminemia, pre-operative anaemia, general anaesthesia, higher American Society of Anesthesiologists score, more intraoperative blood loss, and longer surgical time. Increased hidden blood loss, deep vein thrombosis, superficial wound infection, and prolonged hospital stays were more common in transfused patients. The C-index of the nomogram model was 0.848 (95% CI = 0.811-0.885), and the AUC value was 0.859. The calibration curve showed a good consistency between the actual transfusion and the predicted probability.
We observed a transfusion rate of 30.7% in elderly FNF patients undergoing hemiarthroplasty. CKD and hypoalbuminemia were firstly identified as independent risk for blood transfusion. In addition, blood transfusion can increase the occurrence of early post-operative complications.
Targeted pre-operative intervention, such as optimizing CKD and correcting hypoalbuminemia is essential and highly regarded.
接受人工股骨头置换术的老年股骨颈骨折（FNF）患者通常身体状况较差。本研究的主要目的是确定这些患者输血的风险因素，并构建一个列线图直观地预测输血需求。次要目的是检查术后 30 天内输血与并发症之间的关系。我们的假设是慢性肾脏病（CKD）和低白蛋白血症可能会增加输血需求。
回顾性收集了 414 例接受人工股骨头置换术治疗 FNF 的老年患者的数据。进行单因素和多因素回归分析，以确定输血的独立危险因素，随后构建列线图。通过一致性指数（C 指数）、接受者操作特征曲线（AUC）下面积和校准曲线评估列线图模型的区分度和校准度。此外，还分析了术后 30 天内输血相关并发症。
在 414 例患者中，有 127 例（30.7%）接受了输血。输血的独立危险因素包括 CKD、低白蛋白血症、术前贫血、全身麻醉、较高的美国麻醉医师协会评分、术中失血量增加、手术时间延长。输血患者更常发生隐性失血增加、深静脉血栓形成、浅表伤口感染和住院时间延长。列线图模型的 C 指数为 0.848（95%CI=0.811-0.885），AUC 值为 0.859。校准曲线显示实际输血与预测概率之间具有良好的一致性。
我们观察到接受人工股骨头置换术的老年股骨颈骨折患者的输血率为 30.7%。首次确定 CKD 和低白蛋白血症是输血的独立危险因素。此外，输血会增加术后早期并发症的发生。
有必要进行针对性的术前干预，如优化 CKD 和纠正低白蛋白血症，这一点非常重要。
