Using Fracture Patterns and Planned Operative Modality to Identify Fractured Neck of Femur Patients at High Risk of Blood Transfusion

Abstract

Background Fractured neck of femurs is common, serious injuries usually requiring operative management. Red blood cell transfusions are often required to treat perioperative anaemia, but these are not without adverse effects. Aims and objectives The aim of this study is to identify subgroups of fractured neck of femur patients more likely to require red blood cell transfusions. We try to identify targeted strategies to reduce blood transfusion-associated adverse effects and thus improve outcomes. Design and methods A retrospective cohort study of 324 patients. Patients were divided into cohorts based on radiological fracture patterns and operations performed. Data were collected from patient records, picture archiving and communication systems, the local transfusion laboratory, and the national hip fracture database. The primary outcome was blood transfusion rates in different fracture patterns in fractured necks of femur patients. The secondary outcome was blood transfusion rates in different operation types for fractured neck of femur patients. Chi-squared tests for independence were performed. Results 14.9%, 34.7% and 33.3% of patients with intracapsular, intertrochanteric and subtrochanteric fractures, respectively, received blood transfusions. There was a significant relationship between fracture pattern and blood transfusion (X ² (2, N = 324) = 17.1687, p = 0.000187). 47% of patients receiving long intramedullary nails, 45% of short intramedullary nails, 27% of open reduction internal fixations, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions. There was a significant relationship between operative modality and blood transfusion (X ² (4, N = 302) = 22.0184, p = 0.000199). Conclusion In patients who have sustained a fractured neck of the femur, the fracture pattern and operative modality are both independently associated with the rates of red blood cell transfusion. In these identified groups, we propose that increased vigilance and awareness regarding transfusion avoiding strategies are utilised with the goal of improving patient outcomes.

Keywords: anaemia; blood transfusion; femoral neck fracture; hip fracture; outcomes.

Figure 1. Study patients split into cohorts by fracture pattern and operation performed

Abbreviations: AO = AO/OTA Fracture and Dislocation Classification Compendium; THR = Total Hip Replacement/Arthroplasty; Hemiarthroplasty = Hip Hemiarthroplasty; ORIF = Open Reduction Internal Fixation; Long IM Nail = Long Intramedullary Nailing; Short IM Nail = Short Intramedullary Nailing

Figure 2. Transfusion rates in fractured neck of femur patients grouped by operation type

Abbreviations: RBC = Red Blood Cell; Hemiarthroplasty = Hip Hemiarthroplasty; ORIF = Open Reduction Internal Fixation; IM = Intramedullary; THR = Total Hip Replacement