Miyasaki Maurício Rodrigues, Marques Lucas de Quadros, Miranda Thiago Dos Santos, Ruiz André Ruan, Fernandez Karen Barros Parron, Biglia Bruna
Irmandade da Santa Casa de Londrina, Londrina, PR, Brasil.
Instituto de Ensino, Pesquisa e Inovação (IEPI), Irmandade da Santa Casa de Londrina, Londrina, PR, Brasil.
Rev Bras Ortop (Sao Paulo). 2024 Sep 4;59(4):e617-e621. doi: 10.1055/s-0044-1785520. eCollection 2024 Aug.
To identify the predictive factors for the need for transfusion during and after surgery to treat hip fractures in the elderly and to evaluate a protocol to guide the request for blood reserves for surgery. The medical records of 172 elderly patients undergoing surgical treatment for proximal femoral fractures were collected. Data on sex, age, preoperative hemoglobin level, diagnosis, and type of surgery were tested for correlation with blood transfusion. In our sample, we determined the number of units of packed red blood cells reserved, the transfusion rate, and the cross-test:transfusion ratio. We made the same calculations in a hypothetical situation in which the request for blood reserves for our sample followed the criteria of a defined protocol. We found a correlation between the American Society of Anesthesiologists (ASA) classification and the occurrence of transfusions, and an inverse correlation between the hemoglobin level on admission and the number of bags transfused. A reserve of 328 units of packed red blood cells was requested for 167 surgeries. Had the proposed protocol been applied, 72 units would have been requested for 61 surgeries. We found a correlation regarding the variables ASA classification and preoperative hemoglobin level and the occurrence of transfusion. Applying a proposed protocol to decide between requesting a reserve and only typing for elderly individuals undergoing surgical treatment for hip fracture proved suitable to reduce the number of packed red blood cell reserves.
确定老年髋部骨折手术期间及术后输血需求的预测因素，并评估一项指导手术用血储备申请的方案。收集了172例接受股骨近端骨折手术治疗的老年患者的病历。对性别、年龄、术前血红蛋白水平、诊断及手术类型等数据进行输血相关性检测。在我们的样本中，我们确定了储备的红细胞悬液单位数量、输血率及交叉配血：输血比例。在假设情况下，即我们样本的用血储备申请遵循既定方案标准时，我们进行了同样的计算。我们发现美国麻醉医师协会（ASA）分级与输血发生率之间存在相关性，入院时血红蛋白水平与输血量之间呈负相关。167例手术申请储备328单位红细胞悬液。若应用所提议的方案，61例手术只需申请72单位。我们发现ASA分级和术前血红蛋白水平等变量与输血发生率之间存在相关性。应用所提议的方案来决定髋部骨折手术老年患者是申请储备用血还是仅进行血型鉴定，被证明适合减少红细胞悬液储备数量。
