Risk factors of hidden blood loss in elderly patients with femoral intertrochanteric fractures after Inter Tan surgery and its correlation with the prognosis of patients
Yang Huaikuo, Xue Lei, Shang Xiaodi, Yang Gongbo, Mao Dudu, Ma Zhanzhong
Department of Orthopaedic Trauma, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
Abstract:Objective This study aims to explore the risk factors of hidden blood loss in elderly patients with femoral intertrochanteric fractures after Inter Tan surgery and influence of hidden blood loss on the prognosis of patients. Methods In this retrospective case-control study, 65 patients with femoral intertrochanteric fractures were enrolled from the Department of Orthopedic Trauma of Xiyuan Hospital, China Academy of Chinese Medical Sciences from December 2018 to January 2022. The study participants consisted of 34 males and 31 females, with age of 60-87 (69±5) years old. All patients were treated with Inter Tan surgery. The clinicopathological data were collected, and the hidden, dominant, and actual blood loss volumes after surgery were calculated. The risk factors of the hidden blood loss were analyzed by univariate analysis and multivariate linear regression analysis. The patients were grouped according to the hidden blood loss volume. The cases with hidden blood loss volume greater than or equal to the mean value were included in the high-hidden group (28 cases). Meanwhile, the cases with less than the mean value were enrolled as the low-hidden group (37 cases). The fracture healing time and postoperative Harris hip function score were compared between the two groups. The correlation of hidden blood loss volume with fracture healing time and postoperative Harris hip function score was analyzed by Pearson product-moment coefficient. Results The actual blood loss volume of 65 elderly patients with femoral intertrochanteric fractures after Inter Tan surgery was (803.5±126.9) mL, the dominant blood loss volume was (104.8±23.8) mL (13%), and the hidden blood loss volume was (698.3±113.6) mL (87%). Multivariate linear regression analysis revealed that age ≥75 years old, drinking history, time from fracture to surgery ≥3 d, and surgical time ≥60 min were the independent influencing factors of the hidden blood loss in elderly patients with femoral intertrochanteric fractures after Inter Tan surgery (standardized regression coefficient β=0.128, 0.167, 0.113, and 0.109, all P values<0.05). The fracture healing time in the high-hidden group (n=28) was (12.5±2.3) weeks, which was longer than (10.3±2.7) weeks of the low-hidden group (n=37), and the difference was statistically significant (t=3.16, P=0.003). The Harris scores in the high-hidden and low-hidden groups after surgery were significantly enhanced compared with that before surgery, and the differences were statistically significant (F=112.35 and 160.72, all P values <0.001). No statistically significant difference in the preoperative Harris score was observed between the two groups (t=0.68, P=0.502). The Harris scores in the high-hidden group at 3, 6, and 12 months after surgery were lower than those in the low-hidden group (t=2.13, 2.16, and 2.31, all P values =0.502). The hidden blood loss volume was positively correlated with fracture healing time and negatively correlated with Harris hip function score at 12 months after surgery (t=0.412 and -0.301, all P values <0.05). Conclusion Hidden blood loss is the main cause of perioperative blood loss in elderly patients with femoral intertrochanteric fractures undergoing Inter Tan surgery. The influencing factors of this condition include age, drinking history, time from fracture to surgery, and surgical time. Hidden blood loss is also associated with postoperative fracture healing time and Harris hip function score.
杨怀阔, 薛磊, 商晓迪, 杨公博, 毛都都, 马占忠. 老年人股骨粗隆间骨折Inter Tan术后隐性失血影响因素分析及其与预后的相关性[J]. 中华解剖与临床杂志, 2024, 29(1): 48-54.
Yang Huaikuo, Xue Lei, Shang Xiaodi, Yang Gongbo, Mao Dudu, Ma Zhanzhong. Risk factors of hidden blood loss in elderly patients with femoral intertrochanteric fractures after Inter Tan surgery and its correlation with the prognosis of patients. Chinese Journal of Anatomy and Clinics, 2024, 29(1): 48-54.
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