The effect of restrictive fluid management on outcomes among geriatric hip fractures: a retrospective cohort study at five level I trauma centers

Abstract

Restrictive fluid management (RFM) for hemodynamically unstable trauma patients has reduced mortality rates. The objective was to determine whether RFM benefits geriatric hip fracture patients, who are usually hemodynamically stable.

Design: Retrospective propensity-matched study.

Setting: Five Level I trauma centers (January 1, 2018-December 12, 2018).

Patients: Geriatric patients (65 years or older) with hip fractures were included in this study. Patients with multiple injuries, nonoperative management, and preoperative blood products were excluded.

Intervention: Patients were grouped by fluid volume (normal saline, lactated Ringer, dextrose, electrolytes, and medications) received preoperatively or ≤24 hours of arrival; patients with standard fluid management (SFM) received ≥150 mL and RFM <150 mL of fluids.

Main outcome measurements: The primary outcomes were length of stay (LOS), delayed ambulation (>2 days postoperatively), and mortality. Paired Student t-tests, Wilcoxon paired rank sum tests, and McNemar tests were used; an α value of < 0.05 was considered statistically significant.

Results: There were 523 patients (40% RFM, 60% SFM); after matching, there were 95 patients per arm. The matched patients were well-balanced, including no difference in time from arrival to surgery. RFM and SFM patients received a median of 80 mL and 1250 mL of preoperative fluids, respectively (P < 0.001). Postoperative fluid volumes were 1550 versus 2000 mL, respectively, (P = 0.73), and LOSs were similar between the two groups (5 versus 5 days, P = 0.83). Mortality and complications, including acute kidney injuries, were similar. Delayed ambulation rates were similar overall. When stratified by preinjury ambulation status, SFM was associated with delayed ambulation for patients not walking independently before injury (P = 0.01), but RFM was not (P = 0.09).

Conclusions: RFM seems to be safe in terms of laboratory results, complications, and disposition. SFM may lead to delayed ambulation for patients who are not walking independently before injury.

Keywords: geriatric trauma; hip fracture; restrictive fluid management; resuscitation.

Figure 1.

The volume in mL of fluids, blood products, and medications received in the preoperative, intraoperative, and postoperative settings for each group. Fluid volumes for SFM patients are colored light gray and for RFM patients are colored dark gray. Patients with RFM received <150 mL of fluids, and those with SFM received ≥150 mL of fluids.

Figure 2.

The proportion of patients with delayed ambulation within each group, stratified by their preinjury ambulation status. SFM patients are colored light gray, and RFM patients are in dark gray. Patients with RFM received <150 mL of fluids, and those with SFM received ≥150 mL of fluids.