Clinical Application Effects of Different Preoperative Blood Management Schemes in Older Patients with Delayed Intertrochanteric Fracture Surgery

Abstract

Introduction: Research on preoperative blood management in older patients with delayed surgery for intertrochanteric fracture is scarce, especially regarding hematopoiesis and hemostasis. We assessed the effectiveness of optimized blood management programs in older patients undergoing delayed surgery for intertrochanteric fractures.

Methods: This retrospective study included 456 patients who underwent delayed surgery for intertrochanteric fractures. According to the optimized blood management plan, the patients were divided into four groups: group A was the control group; group B received 1 g of tranexamic acid (TXA) intravenously at admission; group C underwent sequential TXA treatment after admission until 1 day before surgery (1 g/day); and group D received iron supplements (200 mg/day) in addition to the treatment administered to group C, with or without recombinant human erythropoietin (rHuEPO; 40,000 IU). The primary outcomes were preoperative hidden blood loss (HBL), preoperative allogeneic blood transfusion (ABT) rate, hemoglobin (Hb) change, and actual Hb drop.

Results: The Hb reduction, calculated HBL, and hospitalization duration in groups C and D were significantly lower than those in groups A and B. The preoperative ABT rates in groups C and D were significantly lower than those in groups A and B, with no significant difference between groups C and D.

Discussion: The results of this study suggested that iron supplementation (with or without rHuEPO) combined with the sequential IV TXA scheme did not show a better clinical effect than the sequential IV TXA scheme in the management of patients undergoing delayed surgery for intertrochanteric fractures. Therefore, further evaluation is needed before recommending iron supplements and rHuEPO in older patients.

Keywords: blood management; intertrochanteric fractures; iron supplements; surgical delay; tranexamic acid.

Figure 1

Flow diagram of patient selection.

Figure 2

(A) shows the mean hemoglobin concentrations of the four groups from post-trauma admission (PTA) to postoperative day (POD) 1, including the decreasing trends in each group. (B) shows the comparison of the preoperative mean Hb values of the four groups. (C) shows the mean Hb values of the four groups on POD 1. (D) reflects the comparison of the mean Hb drops in the four groups during hospitalization. Groups C and D vs. Group A: *P<0.05; ***P<0.001. Groups C and D vs. Group B: ^##P<0.01; ^###P<0.001.

Figure 3

Preoperative hidden blood loss (HBL) and preoperative allogeneic blood transfusion (ABT) rates in the four patient treatment groups. Groups C and D vs. Group A: ***P<0.001. Groups C and D vs. Group B: ^###P<0.001.