Can early surgery reduce the need to packed red blood cell transfusion in elderly patients with intertrochanteric femur fractures?

Abstract

This study was designed to compare and analyse the amount of packed red blood cell transfusions (PRBCTs) in relation to surgical timing in elderly patients undergoing cephalomedullary nailing due to intertrochanteric fractures. A total of 110 patients (24 men, 86 women) who had received cephalomedullary nailing for intertrochanteric fractures were retrospectively investigated. A restrictive transfusion strategy was followed during the peri-operative period. Patient characteristics and fracture classifications, methods of anaesthesia, time interval from admission to surgery (TI) and operative duration (OD) were investigated. The amount of PRBCTs was measured and categorised as pre-operative, post-operative and entire peri-operative values. The patients were divided into early surgery (ES) and delayed surgery (DS) groups based on surgical treatment within or after 48 h of admission. In addition, multiple regression analysis including TI and other factors likely to affect blood loss and PRBCT was conducted to objectively evaluate the impact of TI on the amount of the entire peri-operative PRBCT. The patients had a mean age of 82.6 years (range, 68-98), mean TI of 41.1 h (range, 5-110) and mean OD of 37 min (range, 15-90). Although the amount of pre-operative PRBCT was significantly different between the ES and DS groups (36.2 ml vs. 168.3 ml, p < 0.001), they displayed no remarkable difference regarding post-operative and the entire peri-operative amount of PRBCTs (279.7 ml vs. 189.8 ml, p = 0.064 and 315.9 ml vs. 358.0 ml, p = 0.992, respectively). The results from multiple regression analysis demonstrated that TI did not significantly affect the amount of the entire peri-operative PRBCT. If an appropriate transfusion strategy is adopted, TI does not seem to affect the amount of peri-operative PRBCT in elderly patients with intertrochanteric fractures. Nevertheless, careful transfusion management with a view to compensating for any drop in pre-operative haemoglobin is necessary when surgery is delayed.